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.

The Bad

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.

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6 comments

  1. Thanks for the analysis. I have taken S1 w/ Viti…St. Augustine and Spinal Manip with Dunning. I would recommend both. I believe the more “tools in your toolbox” the better clinician you become. I have yet to attend Mckenzie or Maitland or get certified in any one recognized discipline. As a student, 2 of my CI’s were McKenzie certified and although I adopt some of those concepts/treatments in the clinic I believed (the CI’s) only saw patient presentations as black and white. Its important we appreciate all the revolutionary concepts in P.T. and take on our on effective way of practicing.
    Best wishes,
    John

    1. Hey John,
      Thanks for commenting! Yes, you’re right…you need to see more sides of a discipline to improve your skills. I have improved my outcomes by taking concepts from McKenzie (mainly from learning from Dr. Eric Jorde) as well as other manual therapy approaches through Dr. David Love. I think you need to know what not to do to know what to do.

      Best,
      Harrison

  2. Hey Harrison,

    I am on my way home after attending the MAPS MT-M (Maitland manipulation, Osteopathic manipulation, Cyriax Manipulation) course. I enjoyed the course & the instructor did a great job with presenting the material. I agree with your assessment of the overall MAPS courses. I felt that the osteopathic manipulations were much more comfortable and more likely to cavitate than the MAPS manips & we observed many of the Cyriax manips, but did not perform his techniques due to the strong traction component of the technique. The instructor and my fellow attendees that were certified in MAPS all felt that cavitation was not important, but the thrust was more important part of the technique. This is not my experience in the clinic. My patents comparable signs resolves very quickly following cavitation & may or may not resolve without cavitation.

    Overall, great course & I would recommend this course along with James Dunnings manipulation courses. This will give you a broad apprecitation for different perspectives regarding manipulation.

    I wish the course discussed more evidence in specific terms and not in general terms such as the literature states…. Dunningl’s manipulation course is more osteopathic in nature. His review fo the literature is extensive. His review of the literature is worth the price of the course, but he is excellent in his abilty to teach manipulations.

    I feel that assessing the spine is more effective using repeated motion testing & force progression taught by McKenzie. There is quite a bit of research on directional preference, centralization, & syndrome classification. However, I always appreciate clinicians such as McKenzie, Maitland, Cyriax and other for doing the great ground work. They were willing to be bold and put their clinical reasoning on paper for the world to learn from & critique.

    Thumbs up for MT-M.

    Eric

    1. Thanks for responding Eric and glad you enjoyed the course. Looking forward to talking to you this week about the concepts and strategies that MAPS implements.

      I think you will like the following quote (especially since you’re a UNC fan!), showing the need to turn your thoughts into action, such as Maitland, McKenzie, etc.

      A thought which does not result in an action is nothing much, and an action which does not proceed from a thought is nothing at all.
      -Coach K

  3. Harrison,
    I was certified with maps in 2004. I thinks the MAPS courses are a good intro into joint mobilization and forming a treatment strategy(especially for new grads). However, after taking Dunning’s manipulation classes, I felt like his courses are head and shoulders better for a clinician who has had some time in the clinic and wants to advance their skills.
    Greg

    1. Hey Greg,
      Good to hear your response, especially being a MAPS graduate. Even though I haven’t taken all of MAPS courses, I would agree Dunning provides excellent courses.

      I think his research knowledge is what really separates him, what do you think?

      Harrison

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