Hooves on the ground: Peripheral Manipulation, G.D. Maitland

So, I’m going to start reviewing books that I’ve bought to attempt to manage my hypermobility better.

The first notable thing about the edition of Peripheral Manipulation that I have are the two prefaces; One to the first (1970) and one to the second (1977) edition.

The preface to the first edition begins with “Treatment of painful peripheral joints by passive manipulation has become almost a forgotten art amongst physiotherapists” and goes on to talk about how generally, exercise is a more popular prescription. The preface to the second begins with “Manipulation is now accepted fairly generally as a routine part of medicine.” and talks about a massive sea-change in the practice of physiotherapy. Amusingly, at my first set of physio sessions in 2007 I was treated to a lot of hands-on manipulation, most notably having my pelvis realigned by a lot of stretching and twisting. It hurt, but it stuck. In 2013, on my second set of physio sessions for the same condition, I was set exercises with plenty of touching and correcting and holding parts of me in place. In 2015, my physio set me exercises, but was reluctant to touch me or even look at me.

In short, physiotherapy has fashions, and this book caters to one of them admirably. From my perspective as a patient, both exercises (for strength and conditioning) and manipulation (for relaxation and education of what the correct ranges of motion for each joint are) are really valuable, and although exercises are easy enough to find or deduce, manipulations are much less intuitive.

“Part 1, Theory” is the most important for knowing what and how to do, and for explaining how to assess exactly what a problem is and to put it into clinical terms; It contains a few flowcharts on how to take a patient history and assess the type of pain or stiffness, and explains how to apply a technique at the appropriate level of vigour. It’s a good read, both for working out how to apply the manipulations safely and appropriately to yourself or to another person, and also to understand the kind of guidelines that are appropriate for a physiotherapist to work within.

“Part 2, Joint Techniques and Management” is the bulk of the book, being a collection of ways to move each joint passively, laid out by joint, top to bottom.

The pages for each joint are slightly confusing at first, being laid out acros the double-page spread, rather than left hand page (top to bottom) then right hand page (top to bottom), but that’s more of a minor quibble with how I prefer my iinformation to be set out, and it does mean that paragraphs can be folded up small enough to fit in larger diagrams and their annotations.

Each one starts with a table of examinations, both active and passive, to work out where the pain or stiffness is, and what brings it on. These use a fair bit of technical terminology, which are all abbreviated (the abbreviations are keyed in one of the Appendices) but for a reader who isn’t confident on fairly subject-specific terms for the body plan or movements, it’d be worthwhile to look up the terms online and then annotate; It is a book intended for physiotherapists and students, rather than laypeople, but it’s set out so accessibly that with just a bit of annotation, it’d be very readable to anyone with more than a passing interest in their condition.

What makes it extremely readable is the diagrams – They’re set out extremely simply, with a number of different passive motions per joint, which can be applied as indicated. Each movement is described in detail, around the illustration, with explanations of the method and desired outcomes below it. I found it best to bookmark the ones that I needed most often, and then try them when the joint was not stiff or painful before trying them “in action”.

Of course, this book does not purport to treat subluxations or dislocations – One can’t do any of these movements straight onto a subluxed joint (or if one can, they don’t do what they’re intended to do, and might cause damage) – but I’ve found them to be good for relaxing and settling and generally making comfortable anything that’s stiff or in spasm or just generally sore and unpleasant. Many of the techniques focus on the passivity of the patient, so have detailed instructions to the person performing the technique to allow them to isolate the joints needed and take the weight of the limb without the patient needing to use their own strength.

The final section of the book is “Part 3, Application” which is largely about recording and tracking progress over a course of treatment, and explaining points made earlier in the book in greater detail. This is useful for all sorts of reasons – Not least just to have some objective measures of progress over time, either for personal use, or to show to future physios.

In short: It’s a useful book, either as an educated layman trying to work out things which will make the pain stop, or for working out what a physiotherapist was trying to get at in session. I can’t say that it’s definitely useful for everyone, and I wouldn’t tell people to try to use it as a substitute for proper care from a physiotherapist, but as a tool for educating oneself as a patient, it’s a good place to start.

Exact details of my copy: Peripheral Manipulation, 2nd Edition, G.D. Maitland, Butterworths, 1977. £2.50, second hand.

Disclaimer: Nothing said above is intended as a substitute for qualified medical advice, or to supersede the advice of a qualified physician. This is my personal review of my experiences with a book, as a layman. I am not a medical professional, of any kind, and any health issues should be discussed with a doctor or other appropriate professional.

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