The maitland Concept

Caroline Hennigan

I qualified as a Physiotherapist in 1999 and began work in the NHS. I soon realised my interest lay in the field of neuromusculoskeletal physiotherapy – treating pain resulting from joint, muscle, soft tissue or nerve related problems. Within this field I developed a passion and drive for clinical excellence and had a strong role mentoring students and junior members of the team. In pursuing my own clinical development and education I had several options. I considered embarking on a Masters degree but questioned whether this would give me the outcome I desired. My drive and desire was to be a better Physiotherapist and in the end I felt a Masters degree would have been more of an academic achievement. Looking at the more clinical alternatives, I witnessed colleagues dashing off for example, on a “knee course”, then a “shoulder course”, then a specific “technique course” which resulted in disjointed and ever changing clinical practice. I had already at this point, attended an introductory course to the Maitland Concept and could see that further study in this area would give me what I wanted – a way of thinking and a framework within which I would have the tools to become the Physiotherapist I wanted to be.

The Maitland Concept puts the patient at the very heart of clinical care. Rather than treating a body part or a diagnosis e.g. an arthritic knee, you are dealing with, for example, a retired lady frustrated because she is unable to get down onto the floor to play with her grandchild (because of a lack of bend in the knee, as a result of the arthritis). Already a more meaningful relationship is established. The concept then provides a framework for thinking. It is a unique problem solving approach to truly analysing each individual’s symptoms and subsequent functional limitation, paying attention to the detail and assessing and identifying the most appropriate treatment techniques and methods of implementation (as opposed to following treatment recipes based upon a medical diagnosis, which can often be incorrect and not always relevant). As the Maitland Concept is based upon a system of analytical thinking then it is relevant to every patient and every condition. It is all encompassing and is inclusive of techniques of assessment and treatment championed by other “camps” in the world of physiotherapy.

So I completed Level 1 of the “International Maitland Teachers’ Association” of courses in the UK before going to complete Level 2a and Level 2b in Finland (there were no Level 2 courses running in England at the time). 

I see a wide cross section of patients. The way I work means I am as happy seeing an athlete back to form as I am helping a plasterer back to work.

A typical patient experience would involve identifying their main issue e.g. not being able to participate in sport, experiencing pain whilst driving, feeling anxious about funny sensations in their arm. Following this would be a careful and analytical conversation, which would help me to build up a picture of what may or may not be causing their problem. A physical examination would confirm / rule out the components of the problem. I would then explain to the patient, the source of their symptoms, the reasons their problem developed and the thought processes / clinical reasoning under pinning the treatment plan. There tends to be a physical aspect to treatment with “hands-on” techniques aimed at reducing pain, restoring movement and promoting an ideal environment for healing. Key areas of dysfunction identified during the examination are then re-examined to justify the validity of the treatment techniques used. To support treatment there is usually a home exercise element. Once again however, the process of ongoing assessment and thoughtful analysis means that any exercise advised is based on sound clinical reasoning, rather than plucked from a recipe book (and can be thought of as self treatment).