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Geoffrey Maitland - Obituary

10th Feb 2010

Geoffrey Maitland (1924-2010)

"If I have seen further, it is by standing on the shoulders of giants" - Sir Isaac Newton's quote could aptly be applied to the progression of the physiotherapy profession, and its debt of gratitude to one of its own giants and pioneers, Geoffrey Maitland MBE.

Maitland was instrumental and inspirational in developing the field of musculoskeletal physiotherapy. He introduced careful and precise examination of patients, and emphasised the need for continual assessment of patients that was to be used to guide management. These aspects were clearly the forerunners of what we now refer to as clinical reasoning and patient-centred care. He was passionate about postgraduate education for qualified physiotherapists and this helped to pave the way for our current position as autonomous practitioners, and a modern musculoskeletal specialist profession.

Born in South Australia in 1924, he joined the RAAF in 1942 and was drafted to Britain to fly Sunderland bombers, and to take part in WWII. Whilst in the UK, he met his wife and life partner Anne, marrying in 1945, and sharing 60 years together until her death in 2009. After leaving the RAAF, Maitland trained at the University of Adelaide, graduating in 1949, and later went on to lecture at the South Australian Physiotherapy School. It was here that he developed his special interest in the use of passive joint mobilisation techniques, and the assessment and treatment of patients with spinal problems.

His integrated approach to assessment and treatment of the patient, demanding precise communication and questioning, careful assessment and, vitally, re-assessment after treatment, and the integration of scientific knowledge with the clinical decision making process still underpins the practice of high quality manual therapy. Whilst common place today, these approaches were revolutionary in their time, for a profession that had been so medically directed previously.

Maitland's "permeable brick wall" concept encapsulates the integration of science and clinical practice, encouraging the therapist to balance information from questioning and from physical testing, with research evidence and past experience, to come up with an individualised and specific programme of treatment for each patient. It offers the therapist the chance to break free and be innovative. His suggestion that "Technique is the brainchild of ingenuity" is borne out in an incident from a course Maitland was running, where he was treating a patient in front of students. When asked what technique he was doing, he replied, "I don't know, I've never done it before"- the technique was specific to that individual patient and based on his examination findings only, not on textbook techniques.

Maitland was one of the first to explore the use of manipulative treatments, building on the examination approaches of Cyriax and the gentler treatment techniques of Mennel. His use of manipulation to treat pain and not just stiffness, and work with colleagues to define grades of movement, and methods of annotating this, was ahead of its time. This precision in recording of treatment is a legal requirement today, but at the time was revolutionary, and helped develop clinical decision-making and communication.

He was also instrumental in developing exam-based postgraduate qualifications for Physiotherapists in Australia in 1966, and worked with Greg Grieve to develop a similar course in the UK, which led to the formation of the Manipulation Association of Chartered Physiotherapists, a highly qualified group of expert physiotherapists still promoting post graduate training for musculoskeletal physiotherapists today.

Maitland travelled extensively to share his work and ideas, working with Greg Grieve in the UK, Freddy Kaltenborn in Norway, and Stanley Paris in the USA. With these other pioneers, he was instrumental, in 1974, in setting up the International Federation of Orthopaedic Manipulative Therapists, the first Special Interest Group of the World Conferation for Physical Therapy.

In 1981 Geoff Maitland was awarded an MBE for his services to the physiotherapy profession. Other honours have included the World Confederation for Physical Therapy Mildred Elson Award for International Leadership in 1995, an Honorary Fellowship of the Chartered Society of Physiotherapists, Honorary Life Membership of the South African Society of Physiotherapy, Honoured Membership of the Australian Physiotherapy Association and Life Membership of the Australian Musculoskeletal Physiotherapy Association

Maitland published extensively and his seminal texts Vertebral Manipulation, and Peripheral Manipulation are into their 7th and 5th editions respectively, a sign of the ongoing currency of his approach.

Despite his numerous achievements and accolades, Maitland was known for his humility and graciousness, and his willingness to share and learn with others. He was opposed to the use of the term "Maitland techniques" and very much against guru led approaches, favouring the development of the individual physiotherapist and their own clinical reasoning. These qualities are borne out in the many personal reflections given by those who worked with him, and were taught by him, over his long career

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 post graduate physiotherapy education that we enjoy today. We acknowledge his sad passing and pay tribute to his contribution

Personal Reflection from Dr. Nikki Petty
After completing my Postgraduate Manipulative Therapy course in Melbourne in 1986, I went to observe Geoff for a few days in his private practice in Adelaide. I felt both excited and nervous at the prospect. What was most amazing to me was his incredible humility; he was known to physiotherapists from all around the world, yet had time for me. I remember watching him examine a patient with foot pain and he spent ages hunting around to try and reproduce this guys pain; I can't quite remember whether he ever did manage to, what struck me was the enormous effort and dedication in trying to help him. After this visit I returned to the UK and kept in contact by phone and at various conferences here and in Australia. At an IFOMT conference in Cambridge he publically requested that therapists stop using the term 'Maitland mobilisations', saying that mobilisations are mobilisations and are not related to a person. After writing the foreword to a book on examination and assessment, he said that the sooner he died and let things move on, the better. He felt he was somehow holding things back. Again his humility astonished me. While our paths crossed infrequently, Geoff left a lasting impression on me that I will always treasure. God bless you Geoff.

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