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Editorial

Geoffrey Douglas Maitland

19242010

Gwendolen JullDivision of Physiotherapy, The University of Queensland

The physiotherapy profession internationally was saddenedto hear of the passing of Geoffrey Douglas Maitland on22 January 2010. Geoff Maitland provided outstandingleadership to the profession nationally and internationally.He was a visionary, a master clinician and communicator,a thinker and innovator, a political activist, and an extra-ordinary mentor. His is a life to celebrate. His contributionto the physiotherapy profession particularly in the eld of

manipulative and musculoskeletal physiotherapy has leftan enduring legacy and the signicance of his lifes workis evident today in many quarters of the physiotherapyprofession.

Probably the greatest international legacy is GeoffMaitlands pioneering work in establishing a system ofassessment and manual therapy management of individualswith musculoskeletal conditions, which he began todevelop in the early 1960s and continued to develop overhis lifetimes work in physiotherapy. He was clearly anadventurous and determined man. Some 50 years ago herecognised the need to look outwardly and internationally todevelop professionally, and he travelled to England to studyand learn different methods of spinal manipulation from themedical and osteopathic leaders of that time. Geoff returnedto Australia to develop a unique system of assessment andmanagement. It differed from other systems that were alsobeing developed at the time in Europe and the USA, in thatit emphasised patients, their pain and functional/movementdisturbances. Geoff Maitlands approach emanated froma very patient-orientated basis, focussing on presentingsymptoms and physical signs, ratherthan being based on a biomechanicalor pathological model. What is nowreferred to as clinical reasoning inassessment and management was a

hallmark of his approach from theoutset. In developing his approach,Geoff Maitland emphasised the needfor the physiotherapist to understandthe patient and their pain, itsnature, behaviour, and irritability.Quite uniquely, he developed asystem of graded application ofpassive movement in which passivemovement was used to modulatepain. Historically, assessment andcontinuous reassessment have alsobeen a dening characteristic of the

approach to monitor the patientsprogress and to direct progressionof management. In a technologicallyjuvenile era compared to thepresent day, Geoff Maitland reliedon his extraordinary clinical and

reasoning skills to underpin his clinical theories andpractice methods.

So how has time judged Geoff Maitlands clinical theoriesand clinical art some 50 years on? Time in fact is revealingwhat a master clinician and thinker he was. For example,research is demonstrating that the neurophysiologicaleffects of passive movement are possibly premier in its

mechanisms of physical effect. The repetitive applicationof passive motion seems likely to stimulate endogenouspain control systems at several levels of the central nervoussystem with many studies showing consistent responsesof concurrent hypoalgesia, sympathetic nervous systemexcitation and changes in motor function (Schmid et al2008), as well as a reduction in spinal hyperexcitability(Sterling et al 2010). Rapid progress has recently been madein the pain sciences. The concept referred to by Maitland asirritability 50 years ago may well be analogous to currentlanguage of augmented central pain processing. SimilarlyMaitlands early emphasis on continuous reassessment sitswell with current emphases on outcome measures.

A systematic approach, but a lack of rigidity, dened GeoffMaitland and his approach to the management of patientswith musculoskeletal disorders. He encouraged cliniciansand his students to think, explore, experiment, and create. Thelegacy of this attitude and guidance is that the physiotherapyprofession has had a foundation upon which to exploreand advance both clinically and in research. Australianphysiotherapists have led internationally in musculoskeletalresearch and practice and have produced internationally

renowned clinicians, researchers,and teachers. The philosophy ofMaitlands approach still underpinsteaching in manual therapy in

Australia and many other countriesaround the world. As he wouldexpect and wish, there has beentremendous growth, development,and change in assessmentand management methods forindividuals with musculoskeletaldisorders in response to researchand physiotherapists creativenesswhich he always encouraged.

Geoffrey Maitland was also anoutstanding role model in thedischarge of the professional

responsibility of impartingknowledge to the new generationsof physiotherapists. He was adedicated teacher and gave over 30years of service to education locally,nationally, and internationally at

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Journal of Physiotherapy 2010 Vol. 56 Australian Physiotherapy Association 2010 71

undergraduate and postgraduate levels. He supported thosewho in turn taught both in Australia and internationally.His texts on vertebral and peripheral manipulation and theirrevised editions were the foundations for teaching. He verymuch advocated for musculoskeletal physiotherapy in thewider health eld and, notably, his rst two publicationswere in theMedical Journal of Australia in 1957 and 1961.

Geoffrey Maitland had a vision and a passion for the growthand development of the physiotherapy profession. He had apassion for standards of manipulative therapy practice. Hetaught the rst postgraduate certicate courses in spinalmanipulative therapy in 1964 under the auspices of theAustralian Physiotherapy Association (South AustralianBranch). He, with Marie Hammond and others at the thenSouth Australian Institute of Technology, saw the need tointroduce postgraduate programs in manipulative therapyinto tertiary institutions, so that students gained appropriatetraining, qualications, and recognition of skills. The rstcourses ran in 1974 and now there are postgraduate mastersprograms in musculoskeletal physiotherapy in most statesof Australia and many countries around the world. GeoffMaitland played a key role in the establishment, in 1966,of the Manipulative Therapists Association of Australiawhich has now evolved into Musculoskeletal PhysiotherapyAustralia. He saw the need for Australians to stand tall andbe leaders in the international arena of musculoskeletalphysiotherapy. As early as 1967, Geoff Maitland was meetingwith other international gures to discuss the formation of aninternational association for manipulative therapy and wassubsequently a co-founder of the International Federationof Orthopaedic Manipulative Therapists (IFOMT) in 1974.

Other Australians have followed his path and held prominentpositions in IFOMT.

Geoff Maitland was also a member of the inaugural APAeditorial committee charged with the responsibility ofproducing a national journal (now known as Journal ofPhysiotherapy) in the 1950s. He served as its HonoraryBusiness Manager until 1958. Specialisation is an important

career path for physiotherapists and a way to serve thecommunity with the highest standards of practice. GeoffMaitland was a key player in the establishment of AustralianCollege of Physiotherapists and was its rst president on itsinauguration in 1971. He became a Fellow of the College byMonograph in 1979 and in 1984 he became one of the rstFellows by Specialisation. History shows when there wasinnovation and progress Geoffrey Maitland was there.

Geoff Maitland provided outstanding leadership to thephysiotherapy profession nationally and internationally. Hislegacy will endure and will inuence future generations ofphysiotherapists. He inspired countless physiotherapists tostrive for leadership and excellence in practice and there

are many physiotherapists in Australia and internationallywho would identify with Sir Isaac Newtons words, If Ihave seen further it is only by standing on the shouldersof giants. Geoffrey Maitland was a giant; we mourn hispassing, but celebrate his life and contribution.

References

Schmid A et al (2008)Manual Therapy13: 387396.Sterling M et al (2010) Manual Therapy15: 149153.

Editorial