I had the pleasure of taking the first MAPS (Maitland-Australian Physiotherapy Seminars) course last weekend. For those who do not know Geoff Maitland, he was a visionary in physical therapy practice. He pioneered many concepts we use today in treatment and developed some of the still used examination and assessment modules. The latter is one of the reasons I took this course; mainly to learn his clinical reasoning process of decision making to assist myself in treating, but just as importantly to help teach students. I unfortunately never met him but for anyone out there who does manual therapy, you need to be aware of his teachings.
As for this post, I would like to divide this analysis into the good and the bad, in no particular order.
1. Structured System. I think it is amazing how someone (especially about 50 yrs ago) was able to put thoughts down on paper to create a system. I am trying to do this myself now and it is no easy task. Having a framework standardized in a dynamic field as physical therapy is similar to writing your name in sand at the beach, it will get washed away sooner or later. For this model to still stand shows its structural integrity.
2. The assessment model is phenomenal. This concept uses assessment as its root and promotes re-assessment throughout the examination and treatment. By far one of the biggest concepts that I agree with: assess / re-assess model.
3. The use of a comparable sign. I tend to use concordant sign but either way, interchangeable terms. With the assessment, the clinician is always trying to find the comparable sign, treat it, re-assess it. The comparable sign is what denotes that this is a mechanical dysfunction and one we all need to be able to find to rule out red flags.
1. The passive examination. As much as I like to use my hands to assist in diagnosing and treating, I think too much is devoted in this model to passive examination of the joints. With specificity of treatment of spinal conditions going out the back door and focus more on a functional approach, I can see this being left behind in the dust. It also doesn’t correlate to the vast amount of neurophysiological changes that are more robust in the literature, instead, simply the mechanical changes.
2. The grades. Personally, I do not like how Maitland’s concept uses “Pain and Stiffness” for all conditions, with treatment of pain through grades 1-2 and treatment of stiffness through grades 3-4. For anyone out there who treats with manipulation, you know you use this for pain. It is remarkable for pain relief, bottom line. Don’t limit yourself to beginning grades for pain relief, you will get lapped by the new kid in school.
3. Lack of research. Even though MAPS promotes evidenced-based practice through Sackett’s model, I was deeply unimpressed with the research exposed in this course. If you look in the manual’s literature review in the index, I saw nothing within 10 years of publication. Yes, 10 years. Now I know MAPS has done more than this (even a great research paper last year on thrust vs non-thrust manipulation for mechanical low back pain), but come on, update your manual. Maybe your research comes with the more advanced classes, I do not know. You are supposed to be the respectable leader in physical therapy continuing education.
Overall, this is my impression of the MAPS concept(s). Does it mean I will not attend another MAPS course ever, no, not at all. I really did enjoy the concepts, treatments and especially the instructor. She was phenomenal. I will look forward to the more advanced classes. However, this is intended to provide constructive criticism that could not be written down on the form provided to fill out at end (which is designed to be solely for the teachings in that course, the instructor and facility).
I hope to get some feedback from others on what you thought about my analysis and your thoughts if you ever took a course. Ready…go.