Online Chiropractic CE: Exploring the Maitland Concept and Techniques Posted on Oct 20, 2023

Online Chiropractic CE: The Maitland Concept Unveiled

image of lumbar x-ray on our online chiropractic CE pageCCEDseminars | Your Home For Online Chiropractic CE!In the ever-evolving field of chiropractic care, staying updated with the latest techniques and concepts is crucial for providing the best possible treatment to your patients. One such concept that has gained recognition and popularity is the Maitland Concept of Manipulative Physiotherapy. In this blog, we'll delve into the intricacies of this concept and how it can be integrated into online chiropractic continuing education.

Understanding the Maitland Concept

"The Maitland Concept of Manipulative Physiotherapy, emphasizes a specific way of thinking, continuous evaluation and assessment, and the art of manipulative physiotherapy,". This concept revolves around knowing when, how, and which techniques to perform, all while adapting them to the individual patient's needs. It's a holistic approach that places a total commitment to the patient at its core.

The application of the Maitland Concept focuses on peripheral or spinal joints, each requiring technical explanation and differing in technical terms and effects. However, the primary theoretical approach remains similar for both.

Key Terms to Know

Before we dive deeper into the Maitland Concept, let's familiarize ourselves with some key terms that play a vital role in its understanding:

  1. Accessory Movement: These are joint movements that cannot be performed by the individual and include roll, spin, and slide movements that accompany physiological joint movements. The structures examined passively to assess range and symptom response in the open pack position of a joint, and understanding them is essential in applying the Maitland concept clinically.

  2. Physiological Movement: Movements that can be actively achieved and performed by a person and can be analyzed for quality and symptom response.

  3. Injuring Movement: This refers to making pain or symptoms occur by moving the joint in a particular direction during the clinical assessment.

  4. Overpressure: The joint has a passive range of movement that exceeds its available active range. To achieve this range, a stretch is applied to the end of normal passive movement. This range may cause some discomfort, and assessing dislocation or subluxation is important during the subjective assessment.

Initial Assessment with the Maitland Concept

This concept offers a valuable approach to the initial assessment, enabling practitioners to form a logical and deduced hypothesis about the nature of the movement disorder or pain. It's essential to consider using mobilizations in the assessment process and refer to the Initial Assessment section in Maitland's book on Peripheral Manipulation.

A competent and effective assessment is crucial in any patient interaction. The Subjective Assessment helps determine whether mobilizations are suitable for the patient or if they are contraindicated due to factors such as red flags (e.g., cancer, recent fracture, open wound, or active bleeding, infective arthritis, joint fusion, etc.).

The Objective Assessment allows therapists to assess a patient's joints and tissues by analyzing their extensibility, pain reproduction, bony blocks, or abnormal end feels.

Principles of Techniques in the Maitland Concept

The Maitland Concept involves making several critical decisions when applying techniques:

  1. The Direction: The therapist must clinically reason the direction of the mobilization, ensuring it aligns with the diagnosis made. Not all directions will be effective for every dysfunction.

  2. The Desired Effect: What effect does the therapist intend to achieve with the mobilization? Is it to relieve pain or stretch stiffness?

  3. The Starting Position: Both the patient's and therapist's starting positions should be considered to make the treatment effective and comfortable. This involves how the forces from the therapist's hands will be placed to have a localized effect.

  4. The Method of Application: This includes the position, range, amplitude, rhythm, and duration of the technique.

  5. The Expected Response: The therapist should anticipate whether the patient should be pain-free, experience increased range of motion, or reduced soreness.

  6. How Might the Technique be Progressed: Considerations include adjusting the duration, frequency, or rhythm of the technique.

Choosing the Direction and Grade

Selecting the appropriate direction and grade of mobilization is crucial for effective treatment. Consider the following factors when deciding:

  • Different Types of Mobilization: Each joint has a unique movement arc and direction, and not all peripheral or spinal joints can be subjected to all types of glide. The Concave Convex Rule comes into play here, helping therapists determine the direction.

  • Concave Convex Rule: Understanding arthrokinematics is essential when choosing the direction. When a convex surface moves on a stable concave surface, the sliding occurs in the opposite direction to the motion of the bony lever, and the opposite is true for a concave surface on a stable convex surface.

  • Grades of Mobilizations: The Maitland Concept applies different grades of mobilizations, from Grade I (small amplitude movement at the beginning of the available range of movement) to Grade IV (small amplitude movement stretching into stiffness or muscle spasm). Grade V requires additional training.

Therapeutic Effect: Mechanisms of Action

The Maitland Concept's pain-relieving effects are underpinned by complex systems. While there isn't a single theory explaining its mechanisms, we can explore a few key concepts:

  • Pain Gate Theory: This theory describes how sensory nerves, including α-Beta, α-Delta, and C fibers, interact to transmit pain signals. Understanding this theory can help simplify discussions with patients about pain perception.

  • Descending Inhibition: Pain sensation is subject to modulation during its ascending transmission from the periphery to the cortex, as well as segmental modulation and descending control from higher centers.

  • Blood Pressure Considerations: When performing manual therapy, particularly on the neck, it's crucial to consider its impact on blood pressure. The proximity of cervical arteries makes this a potential concern, and therapists should be cautious, especially in patients with hypertension or other risk factors.

Incorporating the Maitland Concept into online chiropractic continuing education can expand your knowledge and improve your patient care. Understanding the principles, techniques, and key terms associated with this approach can elevate your chiropractic practice and benefit your patients. 

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