The Maitland Concept of Manipulative Physiotherapy, emphasizes a specific way of thinking, continuous evaluation and assessment and the art of manipulative physiotherapy (“know when, how and which techniques to perform, and adapt these to the individual Patient”) and a total commitment to the patient.

The application of the Maitland concept can be on the peripheral or spinal joints, both require technical explanation and differ in technical terms and effects; however the main theoretical approach is similar to both.
The concept is named after its pioneer Geoffrey Maitland who was seen as a pioneer of musculoskeletal physiotherapy, along with several of his colleagues. 

The Maitland technique or The Maitland concept uses passive and accessory mobilizations of the spine to treat mechanical pain and stiffness. There are 5 grades of mobilization in the Maitland concept:

  • Grade 1 – Small movements of the spine performed within the spines resistance
  • Grade 2 – Larger movements of the spine but still performed within the spines resistance
  • Grade 3 – Large movements of the spine performed into the spines resistance
  • Grade 4 – A small movement of the spine performed into the spines resistance
  • Grade 5 – A high velocity movement performed into the spines resistance

How does the Maitland concept help?

The type of mobilization used depends on the severity, irritability and nature of the spinal pain. The mobilizations create movement within the joints of the spine which reduces stiffness and makes movement easier. The increased ease of movement also reduces pain.

The grading scale has been separated into two due to their clinical indications.

  • Lower grades (I + II) are used to reduce pain and irritability (use VAS + SIN scores).
  • Higher grades (III + IV) are used to stretch the joint capsule and passive tissues which support and stabilize the joint so increase range of movement.

Decisions Which Need to be made

  1. The Direction – of the mobilization needs to be clinically reasoned by the therapist and needs to be appropriate for the diagnosis made. Not all directions will be effective for any dysfunction.
  2. The Desired Effect – what effect of the mobilization is the therapist wanting? Relieve pain or stretch stiffness?
  3. The Starting Position – of the patient and the therapist to make the treatment effective and comfortable. This also involves thinking about how the forces from the therapists’ hands will be placed to have a localized effect.
  4. The Method of Application – The position, range, amplitude, rhythm and duration of the technique.
  5. The Expected Response – Should the patient be pain-free, have an increased range or have reduced soreness?
  6. How Might the Technique be Progressed – Duration, frequency or rhythm? 

Who benefits from the Maitland concept?


At Tawam Hospital your physiotherapist will assess your pain and joint ROM and decide which type of treatment is appropriate. It is generally individuals with mechanical pain, such as joint pain and stiffness, who benefit from treatment outlined in the Maitland concept.

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