Early developments in manual therapy

The development of specialisations within the practice of physiotherapy has helped the profession grow and develop as much as it has within the practice of general medicine. One of the earliest and most significant of all the specialisations was that of manual or manipulative therapy.

The manipulation of joints, and in particular the spinal joints, was a long-established folk remedy, practised by the ‘bone-setters’ of the 18th and 19th century. However in the late 19th and early 20th century, advances in surgical techniques and pharmacology prompted a move for the first time away from traditional forms of healing and towards surgical and pharmacological interventions. Tensions developed between the supporters of ‘natural’ remedies, and those who advocated a more scientific medical approach. Since there was a lack of consistency in method or training among its practitioners, manipulation was lumped together with other, more dubious practices in the eyes of the medical profession. Orthodox medical practitioners thus tended to view manual therapists with the same disdain as they gave to herbalists, for example; while manual therapy practitioners for their part tended to be alienated by the conceit, reductionist approach and, to some extent, arrogance, of the medical side.

However there were some medical practitioners who recognised the effectiveness of manual therapy when used appropriately, and who sought to recognise that there was a place for clinically-based manual therapy within conventional practice. In particular, Dr James Mennell (1880-1957) of St Thomas’ Hospital in London, and his successor Dr James Cyriax (1904-1985) sought to incorporate the clinical practice of manual therapy into the trained physiotherapist’s core of established treatment techniques. These practitioners had a strong influence on early spinal manipulative therapy in Australia, both through their books and, in the case of Dr Cyriax, through personal contact with Australian physiotherapists.

One of the early champions of clinical manipulation in Australia was Dr Charles Hembrow (1898-1983), orthopaedic surgeon first at Melbourne’s Austin Hospital and then at the Alfred Hospital. He was a great believer in manipulation and was ‘convinced that good muscles were better than a brace’. It has been attributed to his wisdom that university lecturers in Melbourne were given permission to teach the basic principles of manipulation in the 1950s and 1960s. Two other notable early contributors were Marie Hammond (b. 1931), and Jeanne-Marie Ganne, both of whom trained with Dr Cyriax in the 1950s.

However, the person who made the most significant contribution to the establishment of manual therapy in Australia was South Australia’s Geoffrey Maitland (b.1924). Geoffrey Maitland trained as a physiotherapist at the University of Adelaide and later became a clinical tutor at the South Australian physiotherapy school. Around this time he began to develop a special interest in the treatment of musculoskeletal disorders of the spine, and over time he became an authority on the subject. He studied and travelled widely, and compiled knowledge from a wide variety of sources (including Dr Cyriax in London) - his range of informants ran from physiotherapists through orthopaedic surgeons to osteopaths. He also made numerous first-hand clinical observations. As a result of all this he devised his own ‘Maitland’ approach to manipulation, which had much in common with the gentle techniques used by Dr Mennell and the osteopaths.