Table Of ContentijlTITE~"QRn,
I,E,,·E"A/·:"
MAITLAND'S
.. mmmJ I
Vertebral
MANIPULATION
Edited by
GEOFF MAITLAND
ELLY HENGEVELD
KEVIN BANKS
KAY ENGLISH
SEVENTH EDITION
Maitland's Vertebral
Manipulation
Seventh Edition
Geoffrey D Maitland
MSE. AUA. FCSP. TACP. SASP Mapplsc
Edited by
Elly Hengeveld
MSc, BPT. PTOMT. SVOMP, IMTA Memb"
SellPor ltac~r;
Int~rMrionol Maitland T~chcr'sAsS<.lcior'on. Obcrcntfcldcn, Swiller/and
Kevin Banks
SA. MMACP. MCSP. SRP. IMTA Memb"
Cho~~Ph~or~rop;slROlherlJom, UK
Kay English Dip Tech (Physio), Grad Dip (Adv Mn. MMPAA, MAPA
Privott Proc1itiOflcr. Mtdind;t, South Auwoll(r. Australia
ELSEVIER
fIlrrn;RWORTH
IlU"u.,...""
EOINBURGl-1
LONDON
NEW YORK OXFORD
PHILADELPHIA
ST lOUIS SYDNEY TORONTO 2005
ELSEVIER
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I.lbnlf)· 014.:_11.__ Ca'OII"'J'llnit In l'utlllc:o'ion I)a••
Acal.Ilus"" =-Idl f«1!u> booI.. I> "
....lmlc fn\lll the 1Al<..,. orCon:='
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'kdiall.-Iodae is. coa<UI>'l; ",*"",pnJ. AJ ...... "ll~ bccomn ",-:aibble.
d ....sr- .n ,rc.ol...... proccdufc.<. ~pm<nt """ doe ..., of dnot' ...........~
The ..,""'" _",. puN'''''''' Ioa\r ~ _.10""""'" ,lilt lIoc ",fornwionp.""
",.bO,."" i. ~~..,I0"""'.Hau.'"''''",aJCf-. ~ <tron~ .....i>ed1O
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...~Iq,<LoI .... _~ofpl'x"c..
Working log~ther 10 grow
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.....-..."".._."""--''''-
...
~...~
,,".,.~...
---
--1-"
Contents
Prl'fac~ 10 the seventh edition vii
Prdace to lhe first edition
i~
Biography
~I
Glcssary
J('(
1.
Introduction
1
2.
The lIoctor's role in diagnosis and referral for
manipulaliW' phyo;iolherapy
17
O.A.B,e~rtOt1
J.
Communication
23
wieh Q contribution l:IyJ. Graham
4.
AnesSmtnl
53
5..
PrognosIs
85
6.
Eumin.tion
97
wirh 0 conui/)cjtiOll bra C fdwunJs
7.
Principles of ttthniq~s
111
8.
~lccljon of techniques
183
9.
Application of tcchniqu($
213
willi 0 ('OIIw!Jutioo by B. C. Edwards
10.
CCr'IIica! spine
229
11.
Thoracic spme
301
12.
lumbar spine
337
13.
Silcroiliac region; sacroiliac jei...I,
syml'hysis pUbis
401
14.
Sacrococcygeal and intercoccygeal
rcgioos
411
15.
Examples of tn:atmcnt
413
Apptndi~ 1. MovclMnl diagram theory and
compiling a r!lOYf'mcnt diagram
445
Apptndi~ 2. Clinical C:lilmples of ~mtflt
diagf1lllTll;
459
AppendIX 3. Examirution ,dinem~ts and
moYelTl(nt dillgf1llms
46S
Appendix 4. Oinical lips
469
Appendix 5. Physiot~rlIpy for animals
475
with 0 contribution by r 1. Ahrm
Bibliography
481
Index
487
Preface to the seventh edition
vii
PhyS'Olh(-r~pislS..re being calii'd upon II1creasmgly II...
medic..l praet;1I0ners to t•..-Ip I''''..,n" llUI\"er from
t>pi!iOd,os of uncompliCil.loo
l>I"
~ln'rle/rnechanic.>J.
~pinal d,sonl,.,...
Manipu"'li,·.. Ml)'liiotherapy, il is
de-.u,lus an Important role to pta\ Wllmn!he recm'~
and ~Nbi'ilationproceso>-
Tk ablbty 10 identify and "leal" Ith sr,,,,,1 s..--grnent.>!
mobili!) U!V"inncnl, ni!UlOOyn.utuC d)'Sfuncti<I> and
musoele ,mlxlL1nc{', for .,...mple, "-'quires finely hml-'<i
sk,lls 04 dlnlCilI ",",minahon, duucaJ n~ and
t<-'duuc..l1v a<:(uraleand dl,'Ctive tft'aUTlCllt techniques.
"Th.c r.t:"itland Coocept h.>s bl.'t.'ll 0I1C of lhe con"-.,--
ston<:S of rnQ<I.,m marupuL'IJ'e ph}<IOIh<-npy. Those
who f\.wl' been pnvilcged l'll'-"'gl, IO;l<."c.....,f{ M.lUbnJ
"I w(>r\( will "nl"" how mUch
1)1{)UI~ht "nd detail goes
mlO
Ii~' .\pplication of each individual k'Chnique of
examll1ation, rllQbilisatioll or ",a'u!'u]atic'11, H,wing thp
npporlunity t(l Seol and pra<:ll<X' !C'dlniq""" JX-..-furTTl<.'£1
in an o.pcrl wa...' can onl} sen"C In hdp an} clinician 10
un<l~aJ>d
and
appl}' n",mplllat"e phnio!heTapl
methnd~ mon'dfocb,"el~II' lhecluuc.l setlIng
Wh,lsl le,lbooks can ne\'d" ~titute the- rcal-timo.'
acquisition of lIlo1I1ipu1l.h\"C skU]", they <an act '" a sian·
dard and a rl.ltlio<rn from which the dirnci.ln can
contmue t" impro",' \', ith
llu~ In mInd. the Il!' l!O'.od
7th I'd·bOn of l-Crt..i>l;M :\bllI~~J.uW>"
although hal'ing
cxacth \hie ....1TM' te<l and dcsrnplion of Il.'dmkJue-, is
nuw~ ~ ~tills J*>otosr'.lpl'os and a DVDshow-
ing \id«I dIps or aU rdc\OUII !I,'Chrnques_ 1lus shoukJ
hdp the n'ilder I"see and appl~ mon·d.:arl} asf"-'Cbof
'-"'<:h l...Jmique sucft .... sWrtln" ~'lJun>,1oc.l.l"""lIon 01
lom'!I and "pphc;d>on of fum",
II th""" dmamK additions allow srud''nb of
m,lOipw3tin' ph}>iothc.apy \{) enhance ,heir skills
Mld e>:perls 10 check and refinc their skills and in hun
appl), such skills clinically to help maximi'" p.ltie"t
",'Co"I'<)', then the aim of thi~ rev;.;ed edition will ha'"e
oc'\'n "crue' 00.
Elh I-k'llge,eld - Obrre.,f,'/J("fl. 5"~I;:nIa",f
Ke-"in Bank$ - RI>rnm""fl. Uk
Preface to the first edition
;.
M"l>ipu!Jtion (It the spi"e i>, aS6(ld:llro so oft"" with
fa~ diagnosis at\Cl 'hit or ml~" methods 0; bruh'
force. ~a!i§OCiJll{l11S h.a,·c rnulk'<l in the ",,,Iu"on
of "",,,,puLah'" treatment from rourine phY5'cal ""-,,h·
eine. Ilw caul;0U5 and a~\catt,tude lownds
this t....atment .. oul.l be largely ~;minated if il"'~
r\.'Cognized that rl'll)Sl patient<; can be relie\'ed br the
gl.'flt!er procedun"'<.
Thef-e Me m'o war-; of lIMImpulallng the c~;ous
p..~lknl. 11le first, bo.oU",r thought of as mobilQ,lnon, i,
the gentl", C(~l"Lng of a mOYCml'TIl by p"",i,-" m} th-
mk,ll oscillations performoo within or at the limit (If
the range; the sc<:ood ;s the fmcinl; of .1 mOn'..""nl
(rom the limitofU.... range by a .uddcn thrust The dif-
ference between ~ 1"'0 technique- IN.)" '"l'eIJll"ll'7'ili-
siMI' "·!-.... comp;oring .. stronglv apphl."d moblli/..lhOfl
...lh a GOOtle manipulative thrwot, but ~ i!; an
Important d1h~_"The patient ("In ..lw...~"S It;,bllt1<'
mobil17..ltioo1 if It ,"",>uld berome too painful, wht'n'.lS
tho- suddenr>rSS of the forcrlut milmpulahon preo. ...,,15
any (()Iltrol by the p,'l",nl
TI,e prncli<:al appru.~ch lu th" ",.., of m~njpub,jonis
I" rdate treatm""1 to Ih"patj~nl'.~symptoms and siilns
rather Ihan to dia"noses, Such a plan "Yoid, bolh the
amfusion ,,",u§«! br diagno5tic litl~ calling to mind
dilkrenl 5~ mplums 10 d,f{("l\'nt people, and me (on-
troHr5y .......... pathology. lmieN, 11 i5 often impos...-ib....
10 In...... ..-Nt the In1<' patholog). ;, AI60 " "Ill be
a~ lh.at und.....,. the umbrella of one dlo1gnostic ti:lt>.
fol' ('XiImp...., 'disc ~ion', <vmptoms and si~ ma~
'ill) •.,del}" and n!qu,,,,diffi'l'l'nllrealrnl...ts.
Only th... spinal Ioint>; from I"" occiput
to thl"
,,;,crUZll arC discU5!led in this 1xx,1:. ""d !hI' k~t hM
been planned lu 111"d Ihe reader in logical <t.'<jllCncC
frum the cXil11l111alion of Il,e different inlcnerkbroll
le'cls to the Ier:hnique$ of mobili/.ation applocabl" in
each col><c, Th" way
l~ then prcp"""l for furth"r de"'<,\-
opment inlo lhe mdr" for<:l'ful nu.nipulative pl'OC't"d-
urcs arod
their application. Guiding pnnclpb uf
,reatmt'fll iollow and ~ then applied 10 :<op<riflC CilSe
hisrorie> in the final (Npl(>r. II should be undet"5l00d
tNt ..II
~a!ml.'nl in mis boo!< when dOllll." b) physio-
thc-..arbt, is.,ruyC"amed out on rrw!dical n-il'rral
To the m.my propl.. " 00 M."l" contributed 00 mudl
roward, Ih... final preo;enlalion of lhis Iloool: I.:1m unabl.-
lu "~press m~ grahl\lJ.. i1dequatdy. Will'"ul the con_
.Iruct",~ help of tho,;,: co,><:emro wilh the Iypin!l ",>(1
po,i0!l for Ihe di,'gr~ms, my work \\,,,,,1<.1 h"ve D..--Cn
much more difficult
P"rhculJl people Well' asked 10 undertake 1hI' t",1:
of mildmg and mliazing the m"nu""ripl m d..ta,l. so
lhat il mighl m<'t'1 11, IlNn}" as po:s,.iblc lhe 1lC'C'd,. fur
w!tich II Was undl'ft.llen, and I am!>Ure that the} "'ill
boo abl<' 1O>ol'C how iJ'\,ah..ble their ,,-utdance has been.
In partlCUl,u I "'1Sh to
"~Pll'SS my ";n<:....-c ltunl<s
lo )lbi \I J. H"mmOl1d, ,\UA, MC5r [Teachers
C"rt.), Mis, 1·-\1
Gam~, MCSI' rr"..chers eerl),
~!I.\oS M. Marhn-Jonl::>, MC5P(T"ache.... C""I.). Dr A w.
l:"Hlwl!. D Ph}. Med. M", H. S. Cul,h"w. 8", Dip Ed.
Mr Lansell Bonnin, MCh (Orth), FlK5 ,1I1d Dr Bry,ln
Gandella. \10, BS (1.ldbl, \iRACP{Consult.ilnt Editor.
Austr~Ii4.11 /('1...11I1 of Pll'l"-ii.'l/lffllpll). T"hcsI' persons by
their indi' idual comments and crillos.rn!> ~.... ronsod-
erab~ guid.aoce conammg
d,ff~""1 ~ of the
work. oarnt.~J tht' tcadung of ph}"-';lOtherap} >tuoi<'n!,
medlnl .K'Cq)IoInce and compos'llun. \t) lhank", al'l'
du.. abo tOutr,,-ife .. hoso pairblilklOgly rrnducoJ all
the dr,l,,'iog"-
I ;lm most gratdul for the murt~y \·~tended to me
durin,!; •• =ent .tud} lUI" in Greal Urit,lin.lhc Unitl"(l
5t.lles of Amenca and Cm\,.da
Adelaide
G. D. Maitland
Biography
Geoffrey Douglas Maitland MBE, AUA, FCSP, FACP {Monographl.
FACP (SJ>e{'ialist Manipulative Physiotherapist!. MAppSc (Physiotherapy)
G. D Maidand (19U-J, \\0lSb(lm inAdel.lIde,A....trallol.
tTaiN'd as a pfl)1o.otheraplSl from 19-J6 to 1949 ..fleT
5CT\'U'1g in the RAAF during the M'Cond ~\orld W,]T In
Grt'~l Imlain.
His fi~t job "'Mallhe Royal Adclaid" Ilosp,t,,1 and
tl'le Adelaide Children's Hospital. with il m~in inte~1
on Ill\, trealm('nt 01 orlhopi>l.,lic and neurological dis-
ordl'N;. Later he oonlinuro working part-time m the
hospital and p"r1-hme on hIS 0....." pri' "lccllnic. After ..
fe.... )~'il~ he b«-a"l-.e a parNIm<' pri' at" practitioner
and part-time clinICal tutor at the School of I'h~~o
lh<.'ra~ in IhcSouth A..slr"JWl (nst1luleofT~'Chnolng~~
nOW the Un;"('I"S,I) of South AuslralJ.. lie continu-
ously stud""l ,,"J spent "',If a day Neh w''''k ill the
Barr-Smilh tibrMj' and the exceU"nl library 011 the
Ml"dic,ll School of the Uni""n.ily of Adel~id"
He immediatdy showed ",n intere;l in careful dm-
ICaI {':\.aminalion al'ld as;es;m....'Ilt of patJenb WIth """,m-
m,~dtSttdeTs.lntha;edil}''5~and
tr'eo1tJn('n1 by li"X'fw: p""'in~ movementS "'~"" un<k...-
A.'f"\'S""lto.'<I in phySiotherApy practK\'. G D \-faillo1nd
I..amt~d I~ from OSloop.1lhic, dllropr",clic and
bonesetter boo"s.l5 well "'S lrom medical books such
"" thusc of M"r)in, jo;;te..,
Jilll\~'S B. lI-fl'f11'l'1l. Jrlhn
McMillan "kl\fldl, Alan Stoddud, lI.ob<!rt
,~l"igne,
Edg..,r C\·n.L~, )am("<; erriax and manl' olher<;,
As ,l Ioxtun..... h" ernp~LUd clinicdl t'>:amino1lilm
and a~~1 He slirnula~Siudents to Wn:e lIeal·
Ill(.'nt raords from the "e-ry bt'ginning.. as he- fetl 1....1
'one Of'('ded w comnut Ot'I\.'jlolf 10 p;lpet' to
an.al~-e
WMI one is dOIng' In 1954 he- ~larted with mampula·
the Ihc.apy leachjnG <e:>sion~.
I" 1%1 he ~e'\"l'<!. an ",,,,m; from a Spl'Ci,ll studlClo
fund, which """bled hj", at1d hi, wife A"t1c 10 !il1
O\ers<-",s for a studr tour.
1'1ll1' 'lSlb•...J 06teopaths,
chin'pr<>ctors,
mecbcal
doctors .,nd phvsiotherap\
fflileagues "'hom the)'lwd helIrd and read about and
corresponded with in IhI> p.-..cl'ding \~",rs. In London.
Groff h.>J ,"~tin$; lunchtimt' climea! SleSiSions and
d~ionsWith James C",""" ..noJ hi~ staff From this
tour G
D, \-laltlilnd ~"blishcd a friendship with
Gregory P Gri..,",~ tron1 1110.. UK. They had
t'~tens",,,
correspondence about Iheir dmic,11 ('xpctiencl's and
this conh"u<'d for !l1,.ny y"ars
\-faitland d~1i\e,,::d a p.lper. in 1962. 10 Ihe Physio-
therapy SocIety of AUSlralia enlliled '"The ProbIMru. of
Tmdting \'t'tkbral Manipulation', in which he p"'"
.....nl<'<I a den difh.'Tt'Illiilllon bchn..... manipulation
,JIlt! mobilizanon and Marne a strong advocale of the
usc of genii... p.lssin, mon'menl in the 1"",1"",-,,1 of
pain, in addition 10 the mOre ITad,I,ona] forcelullech·
niqu<'S u",'<i loincR.'a,;(' r,lngenf "1ol,,,n.ln Ihis con\('xt
it may be suilable 10 quol" Jam<."S C:yriax, a f,,\lt1dcr of
orthop.ll!dic mediCIne and of majOr influence on the
dC\'elopmenl of rrwnlpulali\'e therllpy pro\'ick'<1 by
physlOlhl'rapi5ts;
""'" rrr....ll.v .\Iol'IJ.U1J•• pIrysa."~Fl>tJrom
A"SlmJiIl, /fa- Mn e1frpl~/1g"J'I.°III~ thru~'"oJj
J/'<M'r/millmcy !mlll'I/lr mart' ,'rr'lglh Mind II~'",.
TI1eI/ a"ollot i,lemiclI/ l.·itll III<' /lwb,!i;:ms I.-.:IIIII'/,I<'S
tlml O,I"Il/Mlh, ,,1i,.WHlf 'IIrlicoll,rlro,i", I10r lire Ilory
rt.' jrrkv II chiro"rllclol'l" I'''-s..<l''..... 11"',1:"'111 "jrlue
rffl.1l/l/afuls WorK is-,~ tfWmJlim HchJJs fMl
1'J1kf,:dr:f IllS m.1n1l'ld.zlii'f" /tOlll/qur'S ;11/'''' cull, /rto
dJim.; tlafhl'r QIlIOflWlir-tffrd' /lOt tmlllJl'y QrI'''
poirt.1,t'II tndtni.J" got< au! OJ hI) """ Iolar-'.
11r..",.ttml.'Su"""lslIlld '''''',,1><11,11.. prllrlical
rffi>rt ofmalllp"lat'Oll
11r,' ""IWII j, ex<>mi"",f
rrl frrquml i/1lff"iwl, dHr;'l~ Ill/' 1il'S.'lClIl, t(Jf"~H~ Ih,'
llUwjlm/alnr 1<1 a,><,:;S tit" n':'l1ll '111i, trcnlmC/I1
50 ~r. Heron/m,,'" or allers hi, lce/""''Ila in
IXcordfllCt' ll'i/Il ,h,remlsr, IN a/J«'ICfO!dl/lll,l:f,
lklcdeJ ~ ",ohJ~J<mScJCQrly p"",i,k 1M
Mem""''''~Order.." !he Brilish Empi.... in 191\1.
FtlJo>,-,;hip .." I~ ~U-i1h..n College uf
Ph)...iotherilptsts by I-1<.>n<.>gr..pb in 1970, ..-iII1 a
furl""," Fello"-"hip by specWizAtion in 196-1
IioooraJ}' ~reo.-'uf Mas'l'r of Applied 5ctencc
in I'hysioU\('r~py1m", Ill<: University "fSouth
AI.l~traTi~'" 1986_
tiooorilry rdlow of th"Ck;'r1"n..xl Serlet}' 0(
Phvsi<.>therapy (CD)
J-iorIor~ryII(e ...emb"nlll!", ui the Se.•J1h Ahirnn
!'oc~'" Phr"lCJtho,np~.including the Group 01
\bnipulab..,(' Phy-srotl\eQp~~ M......pulab\'t'
rhv.wthc..apy Association orAustQ.l1. (~1PAA),
Sw,ss A""'-'Ci~linno{\1anlj>ulatiw I'hysioth"r.lpy
(SVO:\l Pl, (;(>nlla" A,..)('iMi,m of "1an unl Th<:mpy
(OVMf) and Ih" American l't1ySiC.l1 The,apy
A»ociation (APTA).
tw "",.,.n.,J ..., a\"".d lrom IFOJ.,IT in app"",;"tlQn
01 hl$ .......-~;u>d I..~dcf'ship from;1$ foun,btion
\llIdred Own Award b\ Ihe World ConkdcT-atioJ'l
01 Ph\"Sica111'lo:"<~py (Wc:rn for his life's work in
19'95'
-
Austrnlian 1"Y"'oolh".aM' A-.ci.Jlioo {APM whcft,
he "-015 on IheSlate branch comnunec for2~ \'t.\1J'li
in \ ..OOu5 cap.1Citi<.." ilnd iI Stat.. OI,"-,*,t" to
Fed!'ra! (",neil ior II ye,lrs. In cuuf"nclion ....ith
"thers. he was rcspon..'ibk for the "",,-,ion 01 the
stitu!ionofAP/\ in 1~1%~ In Im,hepul
fo.ward. submi:>sion f>?golrdingSp«ulizahOll in
\I.""puLtt"e l'hysicothefilf"; a<.V<'lC'q)r ..-hich ......
.,..b>equ.,mly acr<>plcd in n>odifJed lonn
lnaugUlall'<esld""t 01 U",A"",ualian CoIkogc of
Ph\~oIh<:rar"t:s fors" )'''U"S and a " ....-mlx.... o/lhe
Cl.,,,ncil fora furth<.... s;",p,"''S.
Member o( tI~ Ph)"'iOlhl'rap~' ~cl>l.lrallon Uoord
of500.lth A~trill;" fur 22 Wilrs
Chairman ,>I rhe &pt'M I'anef for 1'h~l'i<.>IMilpy
for Ausl... I~", Examini"lC CoullCll rorD-..........s
I"'} .......therapbt5 IAECOP) lor 11 )'Nf$.
Austrilhan d,4"'!l"1e to IfO\tT for fi\e )·""<5aOO a
m<."n'lbcr ofl~aCJd"mic "bndardscommitf('(' for
.111".her fil'e r"MS
For hlJ; work he w~s hon.)u .......J wilh .,.,\er~1 aWilrd~
in 1M '" Zur.wch,
Swlt~l'rbnd, the 11l1"m.,tional
Mulland T,"..d ....-no' A'>SOC;i1l1on (l:\IT,\) .....as found...,j,
G. D, Maitland I:>o!c.",., .. subst"",i,,1 contributor 10 th..
AII!>/",t.", j'lIlr>l1l1 <"f PI'Y'J",/IWl1lj'll ..s ...,,11 a~ to other
m..-di<:lol an.! ptl\'5olothe1ap\ joumab ""OfW" id.. On
the instigation of Monica M<l,tin-JOIWS 06E. a Iead...-
of the Clwtcmt Sodet\ of l'hy,...oChera~
In Cre.ll
Bnla,n. M':lI''''''''' was
a~1o:ed 10 publO<h ~ ..."Oli<,
which "-",ult..,,j In th<.· fi~t ,-od,tlon of \hlrl>/lll MIl"'I""
Inrum in 1%-1. whIch w~s 10110\\,('(1 by J !'oC<ond ,-.,j,lioo
io 1968. Tf\c fir>1 c'dihon (If I'c~'wh,'ral Mo"ip"lalio" WM
published in 1970, in "hid.. the famVIb 'm"'eml.....r
di.lgram' wi\S inlrodw;OO. .." ..a,lic... co-producrion
..-ilh Ms}ennikr Iliddifls III 1965_
0.''-'' all tho:' rurs of Ift:turing "nd
publb.h.in~
M...tLmd kepi tINting patients ill> thto clmical
"OJ~
",mallled
hl~ m.l1n SOU= of learnIng ..nd adaptu'8
ide"•. Geoff tre"tlod pati('JllS in his pri"M" prM'h«1 for
0\-'"
~ yean; Jllli although h" doscd hi, pr"clI,,' 111
1965. "" r<:maintd Jcti,'e in treatingp.lti"nt> unt;119'I~
In 1965, one of M..Jlbnd'ji wishes Came h11..; With
the hdp 01 ~h 0 ...... C.......a..'Y, Hei\d of !he PhHlo-
lhcrap> School South A=Ir..i...n In',,ululI!.'' of Techno!·
OS)' and thl' South Ausl1'lIli<'In Brandl of the A""trahan
1'h~."".u..'I..p)' ...~tion, the fiN titrel.' ITU\lhs OOUI'lll.'
on M"llIpu!.>tlQn of tll.. Spi...• was n..ld In AdeLudc. In
197~ this cvur.;e d",e]"I"-,<1 Into tne Oil" ye,lr p<.n>t·
sr..duatl'oo""ativll 'postgr,;Ju.Ill'diplom... in marupu'
br;v" phy<iulhc....p~' atlill' South AUStralian Instltut"
01 Technology, no.... a :\loOSkn ~ <OUt'5<.' ..I the
Uni"'~r5"ty of50ll,h Alblrall3.
H.. WlIS ON' nf Ih<- co-Iouod....-s.. III 1974.. of I.....
Inr.........rional
f-edcr..hon
01 OrthoJ'al.'dic
M,}Jlu,,1
1ll<'.apy (IFOMT), a branch <.>i the Workl Conf.xl.....•
at,,,,, of l'hysi"llwlOlpy (wei'll
Only in
197~,,, hilc tl'aching one oi hi!; fi,."t ""uN'S
in cuuhnental Europe in B"d
Il:aga~, S",uerldI1od, llid
he ~, through
d~on ....·ilh Dr
£Inn.
lJ'm>o:tor 01 !he MedKill Cli..... and the P<Jo"IgradUoll<'
Studv Cenl", in D.ld Rag.oz. tlut in f.."lC1 IUs work and
itk>..s ......".., iI specUJ(: COllCl'Pi of Ihooghl and <'CIi<>n
~ather than a methQd <.>f appl)lng lJIolnlpulatke lech·
ruq\ll-'S. T..... MaitlM'Id C<'>llccpt of\lallipulati\'e Phys.o-
thcr,lpy 'IS il!x-eame !.:nown emphiiSILCS a "P"Cifi< w,ly
(II Ihmking, cQT1rinl>Ous c\'ah",li"" ..nd
i1,;,;e,.~ml"'"
r
':~~-'-'-",-"-'-'''1i-'d-'''-;'-'''-'-fu-'_--''i----''-"d-'ho~'-n-"'-~-'-"P-"-"-"-"-P-"-"-.-""'-"-'-P-Y-(,-k-OO-"
MtllOpanlic ftlnf""lJ~ a",I-I"'ft,'I' ~fjll, u'ill,.OJ
wh.."" how lInd
whl~h
k..,h"iqll~'S to pcrfonn. nnd
;"Irrxf"c/i<m II) ,I,nll. Sll~ smIJ, rmifi<t<'llC<'f"''''
a,J~pt th.-'SC to tile individual situation of the patient')
MillS .~...,tI~ IJWI"""""'" ,,,,d. if/I'" C""" ""po",I,
and .. total (ommitm..'n' to Ihe patient.
8\'11
,..Yl1 -«Ii IW furtl'"
M.liUal1d 1\.;>5 held " ~ .md ""h...ui...· comm,t-
C. ria~ 1 /19'4) T.....lbooL 01 Orthop.K'dic
"...",llo , ..riou:; prnfCffiion.,1 lIS.'lOO.1hOf>S:
~foo..:.."" Pari II - Treatl1\l"111 b\-
Manipulalil.... '\fitSSolgt'.nd 1njt.."C~
11th Ed,U<m.
(1l.>IIicn.~nn;Jall, umdon. P"S'" -10-11)
of .... hkh G. D. \laitl,md is a founding member and
inaugural President
A1Ithis w(If'k w(>uld f!N M\e l>een po;>;oJl>le" linout
the kwinS ~uppnn 01 Ills wife Anne. thl.. rnotheT of
Ihcir Iwo chikf"-.... john ..nd Wench: Anne did most of
t..... graphic art;. if! MdJlbn..l·s put.licdlion", l"J'I ""te<,
rna<Jt.
manllo<npb and
ndcotaped
J1\dny of hi_
rours&. Tlw1r continuous fc!Idbad; di"",-p1int is ont'of
m., \"'"
str~fll;th,>of the M...itlands, who an' pracl1t'-
ally illSt"parable SUlC\: II.-') mel in England during
:;aund World W,lf Anne wilS aw",rdcd m.:- pruloc-
I"'less of the
Dutch
As5ociation of Orthop.-.cd1C
M..nipul.1I"·... Ther-..py (' VO~Il).
M"itbnd's work, <'!lpeciall\ through I"'" mod.. or
thinking lind the
pl'OCt.~ of conlinuo"," ,l5'ieSo""-'rlt,
has l<lid the foundation for the ,.k·n~lopm\'r't nf con·
k'11lpordry dehrntlon~ aOO d\'SCriptiolls of the physio-
therapy proct'SS.
Within this
conl<'~t it S('\'ms suitable 10 conclude
with a q""h.' f""n1
Pn.J(~wr
L,nce
Twom~', Vice
eh,"'cdlor, Prtlre~rofI'tly"mtherapy, CurtLll UJ1I' l'r-
sily of Te<:hnoloflY, l'i'rlh, Australia:
Mail/mld'_ ,'IJII,lwsi' PH ;'Cry.areful and
Ci''''I'I'f'llrJ'5il'<' ""'mllma/i,m 1~lIdi'lg 10111"I"''l:i""
11!'I'I~,7Jt"JJ 'iflr(l1lm",,1 by m01't'mmll1nd foJlolr'/"li
ill IlI,n by lI'fll_<r<SM'J!I oJ:l/;, ''!(.'f:< ofll~ll
"""'("Intlll 011 tiN' pilllt'lll. /Vl'''' lire!J:J,,,,{iJ, Ille
n.uffll riillieo/ IIPI'roWell, TillS b l'robIlbly'hdlN' I'
1Iu' ,;n,~11'6c nll'lhcJ11>'''' po1>;,/['/1' u·;thin tilt di,fi(nJ
,..odin' c{Jt/:l/~IC'l/IIh/'raI'Y ulld ...~ "" If mMrl1'll'
oil," ~1«Uf/llmbofII.' prP//'5<ifpll.
Furt-""ord in ~f'!'haUS{' K &Gass [
(1995) MJ,<cItlo4r!tIO! l'h!,-"",IIImII"'·
But!('fWorth-lleinemann. O\fcrd Pag" IX
810graphy
xiii
Eatii"r in 1987, TImml'\'. ha\'1n~"uHb'CSledMaitlaoo
~tlO\Ild ,,'rill' about hIS WfItnbuhOfl s.ud:
/11 myl'ito1'. thl'A-1JJit..llIdtq:pnlIlfIllOlll'flll'lt'T"
di'frrsfron' "t~, "d i>1 tI", IntdldPll('S iffl.
I«J",iqlli'. M,I r,~111T III IF, 1lJ11"TWdllc Ill.' IVUrIll
alld his l'dltKTl!4r /'TC'NrolI. l,-llraffmlllln Iotktllil
ii' tTJnO.Ii,ra'i'I''1, Ir",11IlI"ll Il"J rr..pt}fN i~ "/Jill"'" in
pI'lf"lUl/ fl>mzl"f /uw /l'(iic';" .. UVrlll spclllll;( 01/1
ill <tJ'fl{'drl.:l,;;
1/1(' dm-k'V,.1<'tf1 i:" lfl)U' 0111''1''. if_'rmll
IIJld ImlTr'lml;
tIl'llT 1'~!;tm<1'('II ",,,,,,Jfi.",tJ.lI. 1I<'oflolsK
bioIogicul b,.~~·/.,,f;(...;
iI,e 'r«rs':;llffo, l,i;;11 I.· ."" ,t!slil/.
tr,,·n.'t1ulum rftl/f","'....pto. II JIJ mll w,,'t:' I"
.¥"" fllllyJrn'/0I".J /""
I~ If linus IIJI"';.
d'"1~IOJ'i"lI ""J nkll.l",s;
II", IJff,'S,illffi" .Id'Iilt'd i'.m'IIIJ1,III"" mIdfor the
I'.",m""diOl'l/m'I"'ml/r" .....mmilwlio'IIII'I''''''r!'
TI,i, u,,'/I i.< 11'C11 1<'orll, "("y <,,'mi,I,'mN,' '11I"lIriOlI
1t....·<1tN·. 11'1'1". ili~tl,e''S'' ..I!'''''lf'/I.1i11l1,IIl.r'
1\\T.ml'\·, L 1. ~nd
T~\'lor, j, K (1987) 11,1' M~illand
O>nn'pt: As:;essml'fll'. E>..1D\inaII0l'l, .1nd T",alment
by I'as:;i,'c ~lo\'CmclIl. Ed~ PiI.lf.'iml TIK'nlI'Y of II...
Lou..., Burk Churchill Li"ingslone
t'JI}' H{'flge,·etd
Ka)En~
Ke\in BanI.,.
Glossary
ACCESSOIO' MOVEMENTS. (a)
[>~ssi\"e ae<riSOrv
mh·"crtL~)r.ll mm,,--menls, I'AIVM; (b) Pa:;:;i,'" intc;-
costal n'o,"errw.'flIS, PAICM.
ASSESS\1£N'T This term Iw; three defllUliorIs:
1.
A!i5CS6mmt 01 the lindmg;;oilhl!eummilbonofa
palJenl"1Udl g;,..... 1hc L""ul.iner lilt- informal.,.,
l'l."lUln!d Ie) rn.:aIoc- a diagno>is. Some (O\.Illtrie!; use
the term [V,\I.UATIO:-.l f;;w Ihl> aspo.'Ct
2.
AsseSismmt of the change.. wtuch lake pLoc.. as ..
!>!Suit of the us.: of a t«hnlqU", to prO'c Ihe clfed
of the te.:hnique on til<' d,>oroL"" al"" to dC'lcrmi""
Ihe <"fll'Cl of the Ircalm,,'" hxhr"qul'S and th.. treat-
menl Sl.'SSiOll> on the disonk•.
3.
ANALYTICAL asS<'S,nK~ll j, ,," il-<,,«menl made
durin);" Ir(>illme"t or ilt the rontlusio" of t~lmeT1t.
It take!; into acrount all d.-t;ub of th,- patient's pil.S1
ilnd pre5Cll1 history. IN.> di.1l:n.l<!lc rle\.il,ls and the
resp0ns<5 to the d,ffert.'fll I",..Iments which ...i11
hi,..., been adminisll"nXl. ThIS mllecbon of mfor·
",,"hon IS analysed so a' 10 alkn.' under!;taJ\dmg of
the hkt"ly fuwwoi the p..I;......'S disorder
ASTDUSKS. The use at ~ ;1' !he n=rding of
each palll!fli se.=UnabOf'l findmgs<lnd IlUItmenl ~
has onh' one rurpose; it is to /''S'''lSlrl Ihe milu' riements
found. n.cu l$' saves recording lim<> ,,00 m.o"-o the
thl'filPlSt quickly ........... of ....senlIilJ romts ...h8l milkirf;
~_..
COMPRESSION. This is Ih"al'l'r<)~Im.ltionof OPpoli-
ing ;oi"l sUr!:t<es, either in a positiun or duri"g .1
m<)"eml~lll, 10 asse,s the .>ource of '1'1l1plorns and to IJ"
used as a lreatmc~11 !<-'Chni,!ue
DtFFEKENTIATION. This arplkos to examination
p~ures Ih"l assess which joint or ~lruClu", is Ihe
<.ot,1"Cl".' of symptoms "'hen rnO"" Ihan one joint or
"truclure is ul\"oh'oo in a mO\'\!lJll'f\1
DISORDERS. Beca~ a Spe"CirK diagnosis IS an a~
of d"lo>nnination which is In!<lu=tly ,""ry dilr.cuJI to
!YUle, the d.,,;criplin· IL'1"m ~ <lS 'the patienl's d ....
order' 15 used in many pl.>o:-.. m the led of Ihis bolllk.
The .....-...on fOJ" u_mg such II term is dclib=l~,t IS m;,>,lnt
[<) Ie",.. ttw ,.,ad.".'. nund fTt"e to "bsorb the ~
oSsmtl..ls of the """""",ted IL':l.1 The ..tlen1ati'e is !II
ta,k in dIagnostic tenl'll>. bUI Itus can oc'COme counter-
prodUCII'!, b)" clouding lhe ,mpocl of lhe relatLod lext
thu" losinS the key of Ihal rel,'IOO le~1
[VALUATION, This term is not u:>ed in Ille 1".\1 of
Ihis book. but it ;s understood to mean a form 01
A~So.'S<->menl (see A,se-smt'nll
GRADES OF MOVEMENT, 5.,... M.,"e"'''T1t
HYPERMOBILITY. Sec lT1stabllity. Hyper-mOOlhl)"
I~
,In
~,"-""S" ..
rang~ of mCl\emC'1lt (e>."mples bein!;
hype"",IL'1lSioo of th....lbo" Of ~..,) for which the.... is
romp"'te mUSClJLuronlrol thu~ prO\idmg~tabilitv"
li\STA8IlITY. This lenn is USt'd onl) 10 meao <In
ncl5SI'"" range of "b0()l'lTl.11 mOH'm..'Il1 for "hlCh
lho.'n.''' no prole<:II,.. mU>oCulolrrontrol.
IRRITABILITY.
Irril1bi!J~' means lhat a btll.. acti.·")
causes" lot of pain that t.ake;. a relalL.-...I}' long bn...
to Ol'1lle" In mill')" cases this is an lndk"tion thai <:iIU-
Iioo
;~ T\.'quired dUTlng ......,lUllolhon and t.-mIn"",1
p-~
1.
Its 5usc'-'plibi]jl} 10 becomi! p.1i"fuL
2.
How painful II oc'l:ome<.
3.
Thl.' k'T1gth of timl.' this 1"'"' takL'S 10 reco"L'"
($<~'J"'1gesS. 116-117).
JOt NT. This word rd'-'n> to all lllol intra-articular slrue·
tur('<;, tilt- capsule ,,00 all Ill.. nOl'-eOT1lraclit" t!.'>,UC5
xvi
GLOSSA~Y
!h.>! move during "'''''ry pas.siV"dOO dcl,,,(' mO,'Cllll'nl.
1'-TRA-ART1CULAR refcrs to llw.'slfUeture(S) (f1) from
thc~bchondral bone to th<> subchondral bone of ~dj~·
a'lll joinl surfaces, .nd (b) including e'n~""1!ling",ilhin
the joint
spac~. ,ncluding
th~ innl'f c"P"u1". PERI·
ARTICLlAR ref...... to 5lructures OU~oi'tIlE' joint. act....-
enol 10 ,..ld mduding tho! au",," rnpsule
LATE.'\lT PAIN. s.,.. I'"in.
LIST. ~ J'roiol'di"e I:lI'formil)".
MA~lruLAnON. l1li5 term is ~ in 1"'0 dislilld
"J}'<;:
I.
II coin be w;<>d 1oo.s<>Iy 10 refer loany kmd of
'p.lSf;I\e lno'emenl" U5O'd in e""lll'fldhon (W
In~ltlll,'nt(",. J',,,.,j"l' \lO\·"m,~,!.and
Moolli~ation).
2.
In a restricted definition, it is u~ed l<l mean.
small-amrlllude rapid mo""nl<-~t(not nl'CC'5,;,lril)'
!"'rf(lrml'<l .lIthe hmil of a rang.. of movement),
whl(h th,' Il,ltknt cann"t p....,'..nt t.lkil1g pl.k;,'.
MANII'ULATtVE PHYSIOTHERAPISTS This term
111c11111es m,lrlll;llthcrapists, c1,nlclan, ,'nd thcr<op,~t<
MOBll.IZATION
Thisisall{'lther'pJ~i"elTlO\('ffiffir
but Its rhythm (X'I' p;lges 5, 176, 179);lOd gr~Je (SlT
p,'g<55, 176) "'" such IMI the p"ti"nl (OT mvdcl) GIn
p"" .....t ,'''' be,ng perlO<'med
MOVE~E"''T. Thh is synonymous WIth the tcml
\fOTIO' which i.> used in ;;()IJU.' EngIisb.-spcaking
countrios. GRt\D£S OF \IOVD1EJ\,T RHITHMS or
\10VE.\I[NT; fhe:!,e MO ter=; SoeI'\'"
<>nI~ one pur-
post', thilt ~ I~' d,·"cribe mol.. ~bbre'\·iotk-d form the
qUilhty of p;>ssl'" treatmenl lIlO\"mrot hems u>ed.
11ll' h.::1"ITlll are not essentLilllO the pr<K1ice of pas.i\';:-
DlO\'emmt treatment.~·a", ~\' U!oed.as iI mlYl\S
of quick l'lX'Ording .u'od c~unk ..tk.n.
MOVE~I[NT DIAGRAMS. The!;e;are txpl.o,no:d in
deMiI,n t"" .ppmdices. Th~~,., nul l...~tialto the
pr;>('l,o' <If I"'illment. lhey do, howe,'er, 1M,.... t"" dl....
lind ...h-anlilse ot fon::ing th" !her..pilit to <lnaho("
whilt .he finds when passi,·"ly moving ;a jo'nl. Thus
the:-'
iI~ iI self-le.minJ; proc~, • toi'<t<hing nl<->di"m
ilnd .. n",ans .)f communicalion.
NATURE OF A DISORDER. This rder. to '''JX'Cts "r
" probl..m IhJI "'quire consider..tion in n,lmi'I.'!,on
,md t",..tnwtlt pmc,'du,('!;. It m..y io(lud,' th" p..tho-
bi"lvgkal rroc,'S.><'s und"rlymg the dborU"r, Wl1tribu·
nnl: f..Clon; such ..s o,teopomsis, stagt of healing,
sLlge Jnd stdbility 01 the diwroer. iln<! c"rtail, p;:r~{)nal
f....tu"--'S such <os tlw f".r of mOl'ing.
NEURAL MOVEMENTS. This 11-,"" is!lti1J nolell'llrl)'
d<'fined, and 15 .1n unfortunate term boxau;;e it can be
misunderstood and prtl"ldl' fud for the disbehe-ers
It refers to ner'''' and thl'lr ,nfmstruclurcas "Til as to
the connecti,'t' tISSue llul support. them and th.......gh
which ~' pas5;
I.
Vcrtd>ral (,lna1
a) duT;a
h) other mminges
2.
Folamin.o.1 canOll
3.
Pt'npheral t1sBueS
a)
neT\-.'$
h) lIlM'shh..II.-...s
c) support"·,, h....Ul....
d) osseofibrous IUnm'!s, <'Ie
4.
Up!"'r limb Ic.nsioo Ie
L~, ULTT Thi.~ is the
eommonl)' uS<.'Cllcrm. but on beconfused wilh
other ,Irudu,...;' 1t....I, ,m''''''mg m"VL'TllL'Tl!>;, AI
this stilge ,t would be !x:lter .If..:l mo....' ilCco>ptf'd by
medic..l pmcl,hon"N if 'upl'"r 11mb ne"ral
mOH'mcnt tests' or'''PI~r limb neural t"sts',
ULNT, "'''''' llSL'Cl,
OVER-PRESSURE. Every
~litll has a J><l'6i\"e r.ng..
of motion, which l';'\c\',>ds it.. ach'l' range. Further nor·
mal mO\em""t c..n be addL'Cl to thil; pilSSive rangl' by
a stretching applkatiOll of o\'eT-pn>ssu~.This O\'cr-
p"",,"ure rilng" ""11 Cau..,., " dL'g"-.... of dis<:omfort or
p"in. iloo should be dSM.'S6<.'d befOf'(' de<:laring a joinl
DlO\en\el\! to be llOI'lTIil!
PAIN. ThIS IS ..-d ill this Ix:lol to ~t many
kinds of ""in and L.......... indud"" oth..'T scnsatlOnS such
"" discomfurt, aWilrcr>£'SS of. lIbnorm.alit., tr.., i"""""
etC. L-\.TE'lT PA1l\, of"hich lhcreare m.:iny prt'Sf.'flb-
lion;; ('"" ""Ses 166, 167. 190-19:!1, refers to ""in and
tile other S<.'flSIborls which do not rome 00 imrnedi-
atclva mo·cement occurs. but ",ther ocnu ~t "arymg
t~ aft~ lhc InO\cmenl, or after a position is sus-
tained. REFERRED 1'1.1:-'"
;am pam. discomfort or
other sens.otion which ill f<'tl III II place whidl isdt>tIlnt
from its SOUl'«'. RADICUl.AR PAIN: Ihis il; iI h.::rm
r,.]atoo to .. rcfcrn.'tl
P.~1Il "hich is &eno.,.ally recog-
nized (rightly or wronj:ly) to be a clearly defined "rea
related to a l\CI'\'C root. THROUGII-RANGE PAIN'
this is,' pain which is fi ....t fcit vcry corl)' in an av,lil-
abl" ran&, of 1l1<l"el1'l'''! and whleh conhn,,~ unhl
lhe limit of th" r""6" is "-",,h,'<I. END OF RANGE
I'AIN, th;, differs from thl' above it1 that the p.,in i, felt
only when
a mO"COlent ha,
rl'"chl'<l,
Or almost
....',]chOO, it, limit of rang". An AFrI;R E1'FECT is quite
mmmon, and ,f pR""",tIS Huh"at;"c of" d,sc dlS()Td..r.
What is meant by the 'I\ft"r "ffl'Ct' is th<ol, having
performed acth'ities in an unfa"uurabll' manncr, the
p;>tio:'nl may l10l "'" a"aIe of;1.5 h.wing any effeo::l BUT
""ill know all aboul it b:o·tl>o.' follo...ln8 mormng.
PASSlVE MOV£MENT. An)" lr\On;:mmt of a mobile
~mmt whIch i> produced by an~ mroll5 otho!!" thdn
the pdrlicuLlr m~ ~lated 10 tlt.ll pdrlKu\.lr Slog·
mcnt's mo'-em....1 is a p.1SSI'-;> ITI(l,'cmenl. It includl'5
both mobiliLllioo and m.anipulahoo,
PHYSIOLOGICAL MOVEMENTS, TI>o.'.c a.... adi,,,
and pa""i,;> funclional mowmenls. P,'>oS,,-e physIlr
lo~ical inll'rverlebral m""cmem (or inlcr-segm""I,,1
movemcnts) is lIob....."i.1'"d 10 I-'I-'IVM
PROOUCEfRErRODUCE. '01.1' aim of physical ">:am-
inatllm is Iv provoke, with lest mO"eml"llIS, etttler an
abronrm.'] I\.'tipol'L<e in an appropriate
~i'e or. whcn
~"Ullcd to lllI! diso<dc<-. ""Production of the ~")'mptoms
G1<»>a"l
xvii
PKOTECTIVE DEFORI\UTV. A ('Ommon 'pmteo::ti'"e
do.>formih~ in tho! cervical!ip1I1e'~ the 'WRY XECK',
",nd m the lumb.~r ,!,,,'lot" is a 'SCTATIC SCOU(})lS·.
C;CIAnC SCOLIOSIS I!! an ,nexact tcnn beau"" lhe
«olio!>i$ (protectiw deformitv) (;lin gcrur without'so·
alic' p"In. Iletter kTIIb are LIST or SHIFf (str P"80
131-132 ,md 350).
RADICULAR PAIN. ~ I'ain.
REFERRED PAIN. Sco.' I'"in.
SCIATIC SCOLIOSIS. 50...: r"'I<'(!ive Deformity.
SI:VFIUTY_ A .ymptom 1S <ldilled as s<'VC'" if the
i>elivil)' 111", Caus<:'> th~ pam n",-ods to be interrurtcd
and
~'0l'rro lx-'(:",,~ of the intensily of the rain
In
many (,1'><'5 this is an indicalion that(aulion is ne«ic.'d
wllh e~MlUnahonand tre<ltmml prucc<lu"",
SHI~T &..: Protectll<' DI,'!onnll)'
Chapter 1
Introduction
CHAPTER CONTENTS
~mov~m~nt
3
Manipulatio'>
3
Mobilization
4
Manipul<Jt,w: Ihffapy
4
~ relationship bctw«n lech",qu~and
asscssrn~l
4
T(c~niq~~ 5
I . ~~~ mode of thinking. the primacy of cJini<:al
Ldence
6
MunipllL1lion is NOT as man)' \\'lIulJ II,.,,' u~ 1.>1.']jl'\'~,
an '~mpincal't"",lm.,nt. Thi~is largdy duo.'10 ad,aoclS
in mockm tI.'dInoJogr. particul.:"i~· "ilh th<> capabilities
ol' mod..'m rompulet'S.- Although mo~1 authors on tlw
~ dt5Cr,bc ll'Chmques and technique! only. lhe 002:1.
err' of this book is .digno.od ""th UIO: foUowmS'luot1lion:
Dt$p,u ,r~ J....,~ pflnr /vmg <.,'IfIU'lhing U; Il
'/>*t wx', ,.mdl,-"'l ~.J.lm-t~ lfilnwlr rlrli,>11TSS.
MtJIlIJ7I<J~litt' t""""p~ lm...!ly~!hI
lMllmnll ,>{ktu·!lIKt p.;in bv~"S r~""lptJ1~
(~""""~OI'~J
t~'bJarlbox' n",."a..q..ny
,mJ MrlJt<.;J;.-"Uyai¥yi"i tlmr -.t,ll. flJll'u/,'- to
bri".~ a"-'tlt _jrr...-..mllJ/roll/ro".... TM ".~f'1Il~~
r!Ju""lllmpI_"'" m~ I/Ii' 'bl""t /lux' M"C"1l"' I~
mf'lvlJI r.TcrpI III /rlOO<' IIls/al/,n U"k'" rrli"blr
ptlllk1IO:S'C'IIJ.'"niols
(!mi' &"'k I'~"" Prn",,,ri.m, Tn'Mnlwl, R""'rl,..h
SYIIII~)silllrl, The /IIanipulali\'C I'hysiOlhempis15'
Association of Australia (MI'_\II), M.lrdl, 1%4)
Although Ihis book is ori..nled ~lmust ~"li,.,ly 10
trnlmcnl by m.nipulalion (i,e, pass;>', mo"..m~nll, il
Dealing with problems of diagnosis lth~
'BRICK WAll')
6
Th«>. ,
"ppropria(~ wording
9
listenif'g
10
wmmation
11
R,lat'''9 m .. tm~nt to the history. symplomsJ
and !>19m
12
~~llt ..lId anatytj(al ilssesment
12
Two mher~nl
capabiliti~s of th~ body
13
Summ~ry: the 'C(mccpt'
14
_
doct not mean thai thdl rn""illuldlion is 'Ihe be all
d"d end all' in the o\'f'rall mdna8emcnt of pal;e"l.
wilh ,'ertebr<l1 di""rd~n; How", ...r, tho.'SCOf'" of appli-
(allon ~nd the sk.llls of manipul,'hon .'''' not sufficiL.,t1)'
....,,11 .lppll.ooaled m many doctor- <100
physi~
dpiMo. II ;,; important, therdafl.'. tnat
"",n;P"I~lion
~Id be gi\ "" ""ITa emrhOl5is so Nt the dpproprbtI,'
~ders, the ~~r.!' and lhe U!lll't'5, will use maniJ'Ula-
non III lis propt'T conlnt and to it" fullest ",,1<-,,1
~t.uupw..tion i5 not lik" S"me of l;OIf (Fig"" I,ll
when! the pLty~ Ux'S a tKhmqlM' to h,t;) batt III III<'
dU1'C'hon hl' wallIS it tu go. allhough most poop~ lmd
to \b(' l<-'Chniqu"", of m.>mpul~h(lnin thIS ....ay.
r. L~lnpulahon is """" like ~ 8"1l1e of..:hl'ss (ri,'U1l' l.2)
"!wI" d,ffl'R",1 'p,("«"<' can b.! mowd in lNnrdiffclUll
and sp«ific wavs, and where plolllS an.' made and
t!e:;lrovw and changL>U unli) tho! l\o,a.l ~ achieved
An even better analogi' is
Ih~ game of Conlra(1
Bndge (FiKW'1' 1,3/. Here (tlmmlluicatim" in Ihe 'bid-
ding', plays an import."'t mil,', a~ abo dot'S the a,S"Ss-
menl of whe", importanl kc" CMOS are hkel)' 10 lx" In
lhe ga~, th.. technique of plal'ing the cards requires
e---------------------
2
MAllLAND'S VERTEBRAL MANIPULATION
Fog".. 1.1
Thrte~hni~ueofgolf
,o",idl'red. thoughtful pLuming. E;,(h facd is UllpDrt-
ant 10 the whole_ and ,,~[h nl"l.'ds to be integrated with
the others with knowledge, skill ~nd experience
The 'conc<->pt', as it has come to "" known, of m,lI\;pU-
lati,·.,trc"lmcnl embraced in Ihis t"xi is ba5ed, sllbj<.'C1 of
COlliSE' !" wa!7'""is, up<m tJx, symptom response (its
slle, its qUQlily and its bch,w;our) to
mr",cm~nh; and
positi......s, It is the mo,-em'-'f1I!I",in response that is half
of the wnQ'PI's keystone. the olr..,r half tJ(,jng "n"lytica1
aSS<'SSJl1L~'t. It is tl.., analvtirul u>Sl.,;smenl that ,.,,,<'als
thl' ch~ngl" in the pain!mmemcnt l"e;p<IfI.WS during
t"'"lmrnt.
Kcyston~> 01 the 'conctpt':
As~sment
M=m~nllll"in f(SpOnSe .nd i~ adaptation in
trcatm~m to thr patknt's current episode
Sr><citk mode of lnin'i~g
whc~ dcali~g wilh a
giv~n di'9nosis
Figu," 1.3
(onl"."t 8rid~
The ",rowlh and
expa,~,ion of manipulation wilhin
roulin" orlhodox m""';cal care is mosl cncour,'ging for
th<.- p",ierot, particularly
,os goveITLrnL'f1t-nccf'l'(litt.-d
postgraduate wur>;Cs are conduck>J in manipulative
phvsiotherapy. al1d also as there is [lOW a 'spe::ialty
quaU/ieation' within the physiotherapy profession in
Ao,lralia_ hen the wort.! 'mampula!i",,' is accept..:1
by 0'01'<.' medical practitioners. This grenter I1Wl1nmess
"f the pl;>ce of manipulation wilhin the con,cn'.,tivc
nwnagemenl of
P.'hl~lts wilf. roeurolnllsculoskelelai
dborders has wme about by a growth in the skiHs and
the applicati<m of them, togdher with a growth in the
ability to ",late the prognosis to the d<'gl"l'C of the
pat;e"t's disability.
There ,lre thn::c m.lin fc"tures about the ways in
whkh manipulation is pcrfornwd today Ihat h,we
made for its more ready acceptance:
1.
The realizahon by tlw medical professiorl of the
emphasis the manipulmive physiotherapist plaa.'S
on
lh~ wnl;nuous analylkal a..essment before,
during arid ~ftcr the application of e~ch lechnique
during e~ch lre~lmenlsession, from session to ses-
sion Ihr(n,!;houl trcalmerll, and Whl~1 I"'<ltmenl
~~
dis<;(mlinul>J
2.
The gentleness of the inilial 1"',1tment lcchniqucs,
wilh stronger k>o;;lmiquC$ ~ing us<-'Cl only wI",,, lhe
inili,,1 ted",i,!u(,,; h"ve Ix",n proglL'S.'Wd gradually
and judIciously.
3.
The demonstrable effecl of such t",,,tmenl and the
rdinl>J information it can provide in terms of dif·
ferenlial diagnpsis and prognosis.
TM l_a~1l§I Kttplancr '" mar PI> al<Oll is du. 10:
Conlln~ IINIytJaJ a~enl
Gtn\ tnei6 ",fin;w' rr.:.tmCrlledln~
Et'ttU of &e rr.:.!J1ICnt ",lid nn 9~ ~.ntmmt
tel d,ffertnlial diag"""s aTd proll'lO!oK
The go.'1M:ral a(cLl'lance of manipulation has nt'\,('rthc--
Ie..;" bet."Ilsluw, and Jnanlpulahon,~still far from "'-oing:
US('(! 10 ils full"'l potenl;a!. There are IWO reason,;. for
Ihis, Firsl, Ihe diagno:>lic
litl('~ u;;ed b}' sum" m<lnipu·
lalON, on which lhey ha"" b,I....~ Iheir manipuI3li"('
treatml'nl. arc unacceplabk 10 Ihe m,liLJrily of the mL'<I-
ical pJ"ft~sion.lhe S<.'crmd "'''SOl' is IMt !l<'me manipu-
latio"," II"." bL,,-'ll performed i"iudiciou~l}', resulting;n
dlSobl..... -
Ih.
liIcTi.lur"
p":)\'id~
thoe e\ idcnce.
HoWl'H'r, such ill(;idcnts >hould bo:' ~n m their nghl
conw..1 Toquot" Brewerton (l~):
Ch'sp'tr ,Itt ~ of11_ Clt$<">, t/try mllst br ltJ'l
i" P'l'PI""iot'; Ii l<tRSlJ IO"¥"Jpall.lJ I<'rll. Ihr
"TXulIfm' IIttJI un1!1fi!¥ srNfl,oJ!.IS ~;VTJ r'. ,~
A",,"lal" liUntl""C>YT II~ (1(10 ........
Dun'llJ ,111$ N1V IIrnr ........ 16 (.lX} _';ipII&iIOO
lI'1lrt",s rrgu14rly .... rh<!M1""T1I 1I~..,n>UIJ be rd~J
upon to Mtmi""lt.lr "I JtusI nl~ rr«t tDdI dar;; 1Ir..f
Illb lWlilJ "",""11 illrrJrnu(l( 1 III 10000000
ItID"'J'ull1",ms.
More 111.'11 40 }·..a~ OIl, IIti.> I> >lilI ",IMi\'('I~" unchang<-d
D,....slers C,lI' be a\'oided by adhering 10 the lollow_
ing three rule>
1.
COlllmuOllS ~n~lvtical as;('Ssm"nl mu~1 be carried
oul during Ihe ~rform"n<;('(Of a Il'(hnique and
lhroughoul treatmenl
2. nu, in;tial ~pphcaholl of a Il.'<.hmque must be
g.....tl('.
l. The SYPII'tomaotic~.both during Mel aIti'"
apphc;r.1ion of tn>atment, m~t bt·aSo5C"..ro and
anal\-sed beftm.> ~g There musl bean
awal'l'f"lCl6 of Lllenl """"""Nliooru.lhal were not
t'\ idePI al the time of the JOllnl consultation and
must ~ clanfied befl:R seloe<ting treatmellt
"""""""
s..>f"re L'Illbartting on the 'concept' 01 manipuLoti\...
lrealmt"'t. \\hich lhis 1>001< ~,ms to dC5CTibO', tl>ere are
I"rm_
related
to
thO' word
'm,lmpul"tIOil
which
requ;n'dMilicalion.
PASSIVE MOVEMENT
Pas~iy" ",o,""menl meanS any movemenl of any part
of one person which is perf"rrfl('(1 OIl Inal persOn bl'
Introduction
J
another person or pieeO' or eqUipment. Pass;\/, rom'l!-
IY\('flI rna\ ref...- to the ,01ll1'S.o«essor)· mov~lS ~
II!; ph\<,ologkal fI\O\·cmcnts. Physiologic...
move-
mfnl~ are tho5o> """""'<MIS that patients can perform
Kti\·e...· br t!I.l'm5el\'ol"); K(K50ry mcn-nnenbii af(>
tho5oe IT><nL'IYlt!I"IlS of tlwtr JOInts thai individuals (.an-
not ptrlonn aeli\ d\~ ""I \\ ruch (.1fI 00 perfornu.od on
them b\ anolt..... p<'IWll. For t'umple. il is impossible
l\l mlal" am interphalangcal joint "'th ely, but il can
be n:;Kall.'Cl b} somC'bod\ l"Ise.1l\en.10"", rotalion "f lhe
lllt"rphalangeal joint is I\n accl'SSOry rnovellK'l\l fur
thai joint. An)' of Ih."., mO\'eml'l1l!; <-an Iw pcrfo'mt'ti
slllwl} '" al sJX'<.'\!, £"Ilily or vigoro"sly and through
iMge ,,, ,m,,11 amplilude:; mld ,Ill! b<.' cal1<'d p"s<ive
llIll\"menls.
I'I-ss~ m~me"1 ft'Ia\I ~f., tell". pnls' acrnsory Of
ptly\iolo~;calff'~nl
MANIPULATION
l1w word 'm.lJUpul.:lt>on' can be> usN ;n man:" wa}"$.
\lC,hCd.l~, il can be used loosely 10 mO'an ~\('
m<:'\'..menl vi am lind. 1here are English
dicti<>n.~ry
dl'flO;IIO£IS or manipulallon. and medical dictlOf\,lry
dettnilioru:. Medic-al dclin;lion, ""1)" ffUm pTad"")I"ll~r
lorr,lClilioo<-r <md from ochooll05dloo1. "lampulahon..
moblli2dhon and pa*l.... rn("'em~'IlI can be, and oflen
MC, ".,..'<1 synonymoush'. t'e\'erth..less, the manipuJa-
I"" phrSLolherapi,t is in a ).'OSllion 10 ,U&;e.l prcci:,('
definitions for lernu usN. In
lh;~ bool<, Ihe "'oret
'manipulation' will be u-.ed in IWo ways
As a gene,al I"rm 10 row, any form of pa~il'e
mm('ffi('Tl1 tedmiqUl" 01 any Siructure as" form of
lre.olnte1,1 for l\I!W'Om1.lXUlosleletaJ disord<'r5. In
Ih", \OJ;(':t wiU {O\'er ~ll formsoipas>o;\'" ......·erncnl
lblN abon', as "'cU as the <J"-"OflC defin,hO<l of
manipu1:ttion \\"hlCh fol],o\\5.
2.
.... ~nique perlortntd ,It a ..".....J such ......1 il has
l.>kn place before the JX'I'lOn on .. hom II is per.
formed is ilh.., 10 preH'1I1 II ~ a mom'l'ul~li1-'r h:.>ch-
mq"" Such
h!chniqu~ aT\! often !,flltle, ..IWa}lI
~1Tld1l in ,ange. and .a...l\ forceful (Oft" P....i"'" 10
for,1 Edihon).
Th~ l~rm mJnip~IMion embrace:; 0111 kird~ of ~'Sille
mOVl:m.nl, Of can be viewrti more $p<':C1fically as a
:>m.11 8mpliwde manip~lalive thfLlSt le<:hn,qu.
perfOlmrti ""Iln speed
