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The IMTA is an international union of committed teachers who provide training courses on neuro-musculoskeletal management based on the principles of the Maitland® Concept.
The Association is committed to standardising, developing and disseminating the Maitland® Concept, and to supporting physiotherapists in its application. IMTA is financially independent and is neutral in both political and religious matters.
G. D. Maitland (1924–2010), 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.
His first job was 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 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 South 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.
He immediately showed an interest in careful clinical examination and assessment of patients with neuro-musculo-skeletal 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 mobilisations, 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 felt that ‘one needed to commit oneself to paper to analyse what one is 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 preceding years. In London, Geoff had interesting lunchtime clinical sessions and discussions with James Cyriax and his staff. From this tour G. D. 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.
Maitland delivered a paper, in 1962, 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 traditional forceful techniques used to increase range of motion. In this context it may be suitable to quote James Cyriax, a founder of orthopaedic medicine and of major influence on the development of manipulative therapy provided by physiotherapists:
. . . more recently Maitland, a physiotherapist from Australia, has been employing repetitive thrusts of lesser frequency but with more strength behind them. They are not identical with the mobilizing techniques that osteopaths misname ‘articulation’, nor are they as jerky a chiropractors’ pressures. The great virtue of Maitland’s work is its moderation. He has not expanded his manipulative techniques into a cult; he claims neither autonomic effects nor that they are a panacea. Indeed, he goes out of his way to avoid theoretical arguments and insists on the practical effect of manipulation . . . . The patient is examined at frequent intervals during the session, to enable the manipulator to assess the result of his treatment so far. He continues or alters his technique in accordance with the change, or absence of change, detected. These mobilizations clearly provide the physiotherapist with a useful addition to those of orthopaedic medicine and, better still, with an introduction to them. She gains confidence from using gentle manoeuvres and, if the case responds well . . . need seek no further.
Cyriax J (1984) Textbook of Orthopaedic
Medicine. Part II – Treatment byManipulation, Massage and Injection.11th Edition.
(Ballière-Tindall, London. Pages 40–41)
G. D. Maitland became a substantial contributor to the Australian Journal of Physiotherapy as well as to other medical and physiotherapy journals worldwide. On the instigation of Monica Martin-Jones, OBE, a leader of the Chartered Society of Physiotherapy in Great Britain, Maitland was asked to publish his work, which resulted in the first edition of Vertebral Manipulation in 1964, which was followed by a second edition in 1968. The first edition of Peripheral Manipulation was published in 1970, in which the famous ‘movement diagram’ was introduced, an earlier co-production with Ms Jennifer Hickling in 1965.
Over all the years of lecturing and publishing, Maitland kept treating patients as the clinical work remained his main source of learning and adapting ideas. Geoff treated patients in his private practice for over 40 years and although he closed his practice in 1988, he remained active in treating patients until 1995.
In 1965, one of Maitland’s wishes came true; with the help of Ms Elma Caseley, Head of the Physiotherapy School, South Australian Institute of Technology and the South Australian Branch of the Australian Physiotherapy Association, the first three months course on Manipulation of the Spine was held in Adelaide. In 1974 this course developed into the one year post-graduate education ‘postgraduate diploma in manipulative physiotherapy’ at the South Australian Institute of Technology, now a Masters degree course at the University of South Australia.
He was one of the co-founders, in 1974, of the International Federation of Orthopaedic Manipulative Physical Therapy (IFOMPT), a branch of the World Confederation of Physiotherapy (WCPT).
Only in 1978, while teaching one of his first courses in continental Europe in Bad Ragaz, Switzerland, did he recognize, 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 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 situation of the patient’) and a total commitment to the patient.
Related links:
Wikipedia – Geoffrey Maitland
In 1992 in Zurzach, Switzerland, the International Maitland Teachers’ Association (IMTA) was founded, of which G. D. Maitland was a founding member and inaugural President.
All this 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 in Maitland’s publications, kept notes, made manuscripts and videotaped many of his courses. Their continuous feedback discipline has been one of the very strengths of the Maitlands, who have been practically inseparable since they met in England during the second World War. Anne was awarded the protectoress of the Dutch Association of Orthopaedic Manipulative Therapy (NVOMT).
Maitland’s work, especially through the mode of thinking and the process of continuous assessment, has laid the foundation for the development of contemporary definitions and descriptions of the physiotherapy process.
……..Geoff will be remembered by countless physiotherapists in Australia and overseas.We acknowledge the passing of a truly great clinician, teacher and mentor. (P. Trott, R. Grant , Manual Therapy, 2010, (15) p. 297)
…Geoff Maitland’s contribution to the physiotherapy profession, and in particular to musculoskeletal physiotherapy cannot be underestimated. His inspiration and collaboration with our own UK pioneers led to the development of the MACP and really set the foundations for all the extended scope roles and postgraduate physiotherapy education that we enjoy today. (MACP, Manual Therapy, 2010 (15) pp. 298-299)
……Geoff was a great listener and a great communicator. He placed a great emphasis on the art and skill of listening [as opposed to just hearing]. He would hang on every word his patients would say so that he did not miss the subtle hints from the language or its tone that would help him understand, in depth, what the individual was experiencing. He would use every facet of “the bodies capacity to inform” both verbal and non-verbal. He would spot the almost imperceptible nuances of the patient’s responses to his treatment. Only he would recognise, in a room full of students, the important meaning of a patient drumming his fingers on the couch. Geoff was a visionary and an innovator. In the preface to the first edition of Vertebral Manipulation [1964] he recognises “The practical approach to the use of manipulation is to relate treatment to the patient’s symptoms and signs rather than to diagnosis” and that “it is often impossible to know what the true pathology is..symptoms and signs [of a disc lesion] may vary widely and require different treatments”
His vision was instrumental in giving us what are now established competencies, including, “Patient-Centred Care”, the use of mobilisation for pain modulation, and an awareness of “the nature of the person” and ist impact on treatment. He highlighted the need for deep and broad theoretical knowledge to support and inform clinical practice. He advocated the discipline of evaluating everything we do to prove our worth and with this came the use of patient reported and orientated outcome measures [subjective and functional asterisks] and the demand for accurate recording of treatment and its effects. Geoff was also at the forefront of research by Physiotherapists for Physiotherapist at a time when it was seen as the role of the Doctor to report on Physiotherapy and decide which Physiotherapy modalities should be prescribed. In summary, G D Maitland supported by Anne and his close family and colleagues has established his place in our profession’s History. He is the Donald Bradman of Physiotherapists. Sir Donald, a fellow Australian, had a career Test Match batting average of 99.94 and, as with Geoff, many have aspired to reach such a standard but none, to date, have come anywhere near.
(Chairman and members of International Maitland Teachers’
Association, IMTA Manual Therapy, (15) 2010, p.300-301)
Within this context it seems suitable to conclude with a quote from Professor Lance Twomey, Vice Chancellor, Professor of Physiotherapy, Curtin University of Technology, Perth, Australia:
. . . Maitland’s emphasis on very careful and comprehensive examination leading to the precise application of treatment by movement and followed in turn by the assessment of the effects of that movement on the patient, form the basis for the modern clinical approach. This is probably as close to the scientific method as is possible within the clinical practice of physical therapy and serves as a model for other special areas of the profession.
Foreword in Refshauge K & Gass E
(1995) Musculoskeletal Physiotherapy.
Butterworth-Heinemann, Oxford. Page IX
(Biography with permission from Hengeveld & Banks (2014) Maitland’s Vertebral Manipulation. Management of Musculoskeletal Disorders. Vol I. 8th ed. Elsevier, Edinburgh)
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