<d;'" '" "LY HHJGEVHD KEvINBA NKS ,. ..." ,. ... ",.. Thicsl astseixcht a sb ecomeo neo ft hef oundatitoenx tfso ra lmlo dernm anual therap.iT shtesf ourtehd itihoans b eene xtensirveevliys beydt woa uthowrhso worked closewliyt hG eofMfa itlaanndd w hoh avea ddedi nvaluaabnldeu p-to-diantpeu itn t he revisiooftn h inse we ditioTnh.ea ccompanyiCnDg- ROMc ontaivnisd eoosfa lrle levant examinatainodnt reatmetnecth niqu.eA slll inder awinhgasv eb eenr eplacweidt hh igh qualipthyo tograpwhhsi c,ht ogethweirt ht heC D-ROM andt heb ook'nse wl ayout, afforadn i n-depatnhd u ser-frieexnpdelryi efnocrer eaders. New fort hiesd ition: • Texits e xtensiuvpedlayt eadn dr evised • CD-ROMo fe xaminatainodnt reatmetnetc hniqdueessc ribientd h eb ook • Highq ualipthyo tograprhesp lalcien der awinmgask intgh et echniqculeesa r eaansdy tof ollow • New chaptoenr C ontemporaPreyr spectiinvP ehsy siothePrraapcyt ice • Additioanpaple ndi'xS:e lf-manageSmternatt egCioemsp:l ianacned B ehavioural Change' • Existcihnagp teerxst endeadn de nhancewdi the vidence-biansfeodr matainodn currepnrta ctice Features: • New user-friteenxdwtli yt hb ullpeoti ntasn ds ummaries • New desigann dl ayouotfi llustrations • Chaptesru mmariaetst heb eginnionfge achc hapteirn,c ludgilnogs saorfty e rms • Clinicaaclcleys sible • Evidence-based • Colouhri ghlighbtoexde tso r einfotrhceek eyc oncepatnsd a idr evision • Clinipcaatlh olowgiyt ht reatmenftorsp athologmiaedse c lear • Assessmeanntdt reatmeonftp atienctlse arelxyp lained • Cases tudiiensc luded Maitland's PerMiapnhiepurlaalt sieornv aessa ni mportarnets ourfcoera lplr acticainndg trainmeaen ipulattihveer apiasstw se,l als p rovidiinngv aluaebvlied ence-btaesaecdh ing materiaanld c asset udifeosru ndergradusattued pyr ogrammes. Thipsr oduicsat p proprfioart:e • manutahle rapists • physiotherapists • undergradaunadlt eecst urers ELSEVIER • osteopaths BHUTETEIRNWEOMRATNHN www.elsevierhea•l cthhi.rcoopmr actors 9 MaitlanPde'rsi pheMraanli pulation ForB utterworth-Heinemann SeniCoorm missioEndiintgoH re:i dHia rrison DevelopmEednitt oSri:o bhCaanm pbell ProjeMcatn ageMro: rveDne an DesigDni rectGieono:r Agjea yJiu,d iWtrhi ght MaitlanPde'rsi pheral Manipulation FourtEhd ition Editbeyd EllHye ngeveMlSdcB PTO MT,vomp SeniToera chIenr.t ernatiMoaniatll aTneda cheArsss'o ciaOtbieorne,n tfeSlwdietnz,e rland KeviBna nksBA M MACP MSCPS RPI MTAM ember ChartePrheysdi otherRaoptihsetr,h UoKm, Forewobryd Peter WeBAlF lCsSPD IPTP SRP ConsultSapnetc iaPlhiyssti otheSrpaopriatsnstd S, p inCalli niFcusl,h aLmo,n doUnK, ELSEVIER BlTTTERWORTI-1 HEINEMANN EDINBURGLHO NDON NEW YORK OXFORDP HILADELIAP HSTL OUISS YDNEYT ORONTO 2005 ELSEVIER BUTTER\\IORTH liEINEMANN C 200E5l.se viLetrd Firpsutb lis1he9d7 0 Seconde diti1o9n7 7 Thiredd iti1o9n9 1 Fouretdhit io2n00 5 Reprin2te006d No parotf t hipsu blicamtaiyob ner eproducsetdo,ri enda r etriseyvsatle omr, transmiitnta endyf oromr b ya nym eanse,l ectrmoencihca.n ipchaolt,o copying, recordoirno gt herwwiisteh,o euitt htehrep riopre rmissoifto hnep ublishoerar s licenpceer mittriensgt riccotpeydi inngt heU niteKdi ngdoims subeydt he CopyrigLhitc ensAignegn c90y ,T ottenhCaomu rRto adL.o ndoWn 1T4L P. Permissmiaoynbe s soughtd irecftrloymE lsevieHre'asl Scthi encReisg hts DepartmeinntP hiladelUpShAi:pa h,o ne(:+ 211)2385 7869f,ax (:+ 211)25 3 8 223e9-m,a ihle:a lthpermissions@e)seYvoiume ary.ac losmco.o mpleytoeu r requeosnt- livnieta heEl seviheorm epag(eh ttp://www.elsevier.com).by select'iCnugs tomSeurp poratn'dt he'nO btainPienrgm issions'. ISBN0 7 506 5594 8 BritisLhi braCrayt aloguini Pnugb licaDtaitona A catalorgeuceo frodtr h ibsoo k isa vailafbrloemt heBr itiLsihb rary LibraorfyC ongreCsast aloguini Pnugb licaDtiaotna A catalorgeuceo frodtr h ibso oki sa vailafbrloemt heL ibraorfCy o ngress Notice Knowledagnedb est praicntt hiicse faireecl odn stacnhtalny giAnsgn .e w reseaarncdhe xperiebnrcoea doeunr k nowledge, cihnpa rnagcetsti rceea,t ment andd rutgh erampayy be comen ecessoarra yp propriRaetaed.ea rrsae d visteod chectkh me osctu rrent informati(oion)n p prrocoevdiudreeds feoar(t iubiry)e d them anufactoufre earcp hr oductto be administteorv eedr,it fhyer e commended doseo rf ormultah,em ethoda ndd uratioofan d ministraantdi on, contraindicIatist t ihoern ess.po nsiboiflt ihtepy r actitiroenleyrio,nne g x perience andk nowledogfte h ep atietnomt a,k ed iagnosetsod, e termdionsaeg esa ndt he bestt reatmfeonerta cihn dividpuaatli eanntdt, o t akael alp proprsiaafteet y precautioTont sh.ef u lleesxtt eonftt hela wn,e ithtehrep ublisnhoertr h ee ditors assumaensy l iabifloiartn yyi njuarnyd /odra mage. your source for books, joumols and muttimedia In theh ealths ciences www.elsevlerheolth.com WorkitnOgg ettoh gerro w libmriinde e velocpoiunngt ries _.dlCVic:r.Ic:o_ m. bookaid.I_o .rs;Igb �.org Printiend h ina v Contents Foreworvdi i 9.R ecordi2n3g7 Prefatcote h ef ouretdhi tiioxn 10.P eriphneeruarlo musculosdikseolredt2ea4rl9s Prefatcote h ef iresdti tixoin Companitoenx ttsot hiesd itixoini i 11.T hes houldanedrs houldgeirrd cloem ple2x7 5 12.T hee lbocwo mple3x5 7 1.T heM aitlaCnodn ce-patn i ntroduction 13.T hew risatn dh and comp3l9e9x 2.M obilizaatnidmo ann ipula-tdieofni nitions, desireefdf ecrtosli,en r ehabiliatnadt ion 14.T heh ipr egio4n4 5 evidenbcaes e2 5 15.T hek neceo mple4x8 7 3.C ommunicaatnidot nh et herapeutic 16.T hea nklaen df oot comp5l2e5x relationship 39 17.T het emporomandjiobiunlltaasrr, y annxd h yoid 4.C ontemporpaerrys pecitnip vheyss iotherapy (thcer aniomandciobmupllaer5x 7)7 practi7c1e 5.P rinciopfla esss essme8n9t Append1i Mxo vement ditahgeroaarmny d c ompiling am ovemendti agra5m9 9 6.P rinciopfle exsa mination 125 Append2i Sxe lf-managesmternatt egcioemsp:l iance 7.P rinciapnldme est hoodfm obilization/ andb ehaviocuhraanlg 6e1 7 manipulatteicohnn iqu1e6s5 Inde6x2 5 8.P rinciopfls eesl ectainodpn r ogresosfi on mobilization/matneicphunliaqtu1ie7os9n vii Foreword Iitsn odti ffitcosu elweth yt hibso ohka sst otohdte e sta ndc linpirceasle ntawtaisio lnlsu,m inaantdii tin sg oft imaen dc ritaipcparla tiosr aela cilt41st he ditiosnt.i cloln,t rtaotr hyve i ewosfa f ew who esneteimtr oe ly Likietc so mpanvioolnu mVee,r teMbarnailp ulaitti hoanv,me i sstehdpe o inavt a,l uable idea. wasi,ni tssl immoerri gvienraslpi uobnl isihne d1a 9 70,S ouncdl inriecaaslo nlionnbgge, f otrheat te rwma s landmpaurbkl icaOttihoebnro. o kosnt h'ew hya'nsd one veryboldiyp'ss, t hwfeao su ndaotfit ohnep io­ how'osfm anipuleaxtiisobtnue ttdh ewye rwer itbtye n neeringo fwG oerokf fMraeiyt laasnr de,c oridnhe ids doctoersss,e ntfioadrlo lcyt oPrhsy.s iothewrearpei bsotosk asn da rticTlheisws.a sn oto nlwyh ath e th'ea lrsaon sN'o.tt raiansep dr imamreyd icdaila g­preacbhuetad l svoe rmyu chs eeinn w hahte p rac­ nosticuinaanbstl,ope r escmreidbiec aotrii onnj oerc t tiseads,t hosper ivilteogw eadt chhi mt reating caroruytm anipulautnidoeanrns a esthtehteaiync d, patiecnatcns o,n firm. thesikri wlelrsue s uarlellye gtaoat s eedc on,dt aercyh­ Hiss ayitnhga' tt echniistq hubeer aincohfii nlgde ­ niciansi nt rhoaels es essamnednt tr eatmoefmn uts ­ nuitwya'sd emonstroanto endeo ccaswihoenna n culo-skceolnedtiatTlih oinassp .p rowaacshi nevitaobblsye rwvaetrc,h hiinmgo na c ourse tarp eaattiienngt , centerxecdl usoinvt ehlmeye dicmaold eolfe xaminae­nquiredw awsth hatete chnhieqw uaesu sin"gId. o n't tiodni,a gnoasnidts r,e atmbeuntit n corpotreacthe­dk nowc"a mteh ree ply "I'dvoen ientb eevfeorr e"! this niquoefms a nusakli clolm monvliye waesd' frionrg ew'a sn oto,fc ourasf ea,c etrieomuasbr ukat,n e njoinder 'alternSaotmioevf te h'e.ss tee mmferdo oms teohpy.a tto" go tahnoddu o l ikewise". Whiltshtse k iolfpl ass smiovvee meunste idnt reat­Thep roceosfos n goicnogn,t inrueo-uass sessment menotfa w idrea ngofed isorsduecrahsst howsiet hina ta lslt agoefts r eatmaenndit tf so llowu-soinnp,gr e ­ orthopaaenddin cesu rolhoagdya ,l waybse eann cisdee,t aiqlueeds tioannidrn egt eshtaisrn egm ained essenptairoatflt hweo rokf p hysiothearc aopmi­stassa, f undamesnttraeln ogftt hh iasp proaTchhi.s prehentseixovtfse u ffiscuibesnttaa nncdoe r igi,n alpirtoyceesxse mpltihfeein eosr mocuosn tribmuatdieo n writbtyea np hysiothfeorprah pyissito thewraasp ibsytG se offMraeiyt liannh di esm phasoint sh iem por­ lackiManigt.l aVnedr'tse Mbarnailp ulcahtainognae ldl tanocfes ubtcloem municaasta if ounn damesnktialll oft haatn dP eriphMearnailp ula(t1i09o)7fn o llowetdob em asteirnet dh per oceosf"s p rovcilnign ically" oni nt hsea mvee in. thvea loureo therwoifps aer ticpualsasmirov vee ment Thed evelopomfea nstp eocft' st hMea itlcaonnd­ strataengdoi tehsae srs ocitaetcehdn iTqhuieisssw . e ll cepats'i tb ecamken ownw,a sf ascintaotf ionlg.l owdocumenitneC dh apt3e,er s senrteiaadli fnogar l l Numerous siudcaehsa' sm,o vemdeinatg raamnsdt' h e medicpaelr sononfwe hla tepvreorf ession. 'gradoifne ga'c the chnitqodu eef iintefs o racne d Anothgerres attr enogftt hhae p prodaecshc riinb ed amplitaunddme o deo fa pplicabteicoanmv,ea luablteh ibso oikst haitti sn on-dogmCaotnisce.q luyea,nn t teachtionofglo scr o mmunicaantdwi eornae n a ttempetv olvkinnogw lebdagsehe a bse einn corpoorvaetre d, ata ccurraetceo rdbiontighnt, h cel insiectatlai nndig n thyee arIsit.s n ot' mae thoor'd s'c hionot lhn'ea rrow thper ocoefts esa chainndlg e arningT.h ec onceptualsieznasI­et.'s o peanp'p roahcahsf aciliat daetveedl op­ tioonfa ni magin(apreyr mea'bblreiw!ca)kl sl e'p aramte­natn de xpansoifto hnwe h ol"ed,e veloapnidn g ingb,u tn otm utuaelxlcyl udsicnige,n ktniofwilce dgeex tendaisMn agi"t lhainmds peulitf(t C hapIt)We.ir t h viiiF OREWORD non ecestsoic thya nigtebs a spirci nciipthl aesbs e en Thee xpansoifto hnte e xttoi ncorproerfaetree nced possitboal dedt oa ndd eveltohwpeo rkC.o mpatrhee reseaarncdoh t hmeart erciaasslet, u dipehsy,s iothera­ sizaen dc ontoefnt th iesd itwiiotnth h fei rst. pistthso ugahntdsh ypothecsleisnp,ir coafli plheos­, Thea uthaorrtesob ec ongratounlta hteesidur c cestso graopfht ye chniaqnudme usc he lsaed dgsr eattol y ind evelotphiceno gn teonftt hsit sh ierddi ttioio nnc ort­he waosra k s tandraerfde raenndca e c ourtseex t, poraatpep,a resnetalmyl e,ts hsaeld yvanmcaedse i n, asw elals a ricsho urocfec linigcuaild anacned foerx amptlhepe,a isnc ienicnte hsle,a sfti ftyeeeanr si llumination. ors oA.n o steo-arktnheiresin toli ocn gveire waesd Itm usts urehlayv bee eann i nspirtaott ihoen simpalp ya infsutlij,fo fib nutat,p roblheamv ilnigk,e a uthotrhsaa t g rowianmgo unotfr eseaarccrhoa s s lowb acpka ianb ,i o-psychcoosnosctiaranuldct th,ii ss widsep ectorfue mx peritnip shey siothaenrdta hpey right. Penroicpihceerppatelir viep,hn eeruarlo genfiice,ol fmd a nipulhaatssit oenm mferdo tmh e teaching centarnadsl y mpathemtaiicnatlalpiyan ieandr e ex am­summariiznte hdib so oakn di tpsr evieoduist ions. plehsi ghligvhatriinagt wiiotnhsni enr vosuyss tem Thef oundatoifot nh eI nternatMiaointalla nd paipnh ysiowlhoigcymh u shte lgpu idaen dm odifyT eacheArs'sso cia(tIiMoTinAn )S witzerwlaasdn ude ouurs oef m anipultahteirvaep y. tot hef oresaingdhd te terminoafat rieomna rkable Howevetrhb er illainadno crei ginoafsl oim tayn y physiotheGriaspeiRlsoatl ,Tf h.i osr ganizhaatsi on ofG eoffMraeiyt laindde'hasas v neo tb eelno sFto.r oversteheen troafit neiancghw ehroas t tetmops ta tisfy examptlhece,o nceopf't i rritaasbd iilsittifynr'co tm thed emanidnE uroapned e lsewhfeorrree gulated, 'severwihtiyli'sth,t a sb eecnr itifcriosamen da rrowh igsht andpaorsdt,- graduaitnet hficisoe uTlrhdse.eys acadevmiiecw point,a v raelmuaaiibnnlsse i hgehltp ­wilwli,t hoduotu bbtee, n courbaygt ehdni esw e dition. intgh cel inimcaikacenr ucdieacli saiboonutsth f eo r­ Thep ioneerwionrgko f GeoffrMeayi tland, mulatoifto hne irt odd aayty r eatments. refleicntt heedps aeg ehsa so,v etrh yee argse,n erated Likewtihsepe e rcepstuibvdei viosf'i oovne russeo'm,he e aitnd iscusbsuitmo,on s itm porlt,yag nrteat 'misu'saeb'u,s' en'eu,ws ea'n d' disutsoie l'l uminaltieg Thhti.ps r eseendti twiiolnil l lumifnuartteih tesr clinsitcaatlie sas su sefausel v eirng ainifnugr thesru bject. insiignhttto h nea tuorfte h ger eaartr oafym usculo­Mositm portaintpt rleys eunswt ist ahn a bsorbing skelpertoabll eEmvset.ne rmssu cahs' unstianbsltea a­ndc omprehetnesxihtve el pitnodg e fian cer ucial biliatnyd'' s taibnlset abwihliichthay v'te h roswonm e parotft hweo rokf p hysiotherapists. moderapteeo pilnet ao r agaer,e s upporbtyea dn underlwyiisndgo m cowuiptlahwe eda lotfhc linical PetWeerl ls, experience. Londo2n0 05 ix Prefatcoet hef ourtehdi tion Thep reftaotc hefe i resdti toifto hnib soo wka sw ritteonfp hysiothperraacptGyiu cied.e lfionares ss essment, 35y eaargsoa ndi sa sr elevtaotn otd apyh'yss iotheexra­minaatnidto rne atmheanvtbe e eunp datweidt h apyp rofesassii twoa nsi n1 97T0h.ea dvanceomfe nrte levant fervoitmdh ecenu crrele intte riantculrued,i ng: orthopameeddiicci amla gianngdd iagnoastnidtc hse, c ontempodreavreyl opmienpn htyss iotherapy practice adveonfet x tensdceodpp hey siothperraacpthyia cvee (Chap4t)ec;rl inriecaaslo nsicnige ntchebe;i opsycho­ distratchtpeer do fesfsriootmnh dee taoifjl o ipnati n socipaalr adiignmc,l udpisnygc hosaoscsieasls ment andt haeb iltiodt eya wli tiht faatcv ea luTeh.em es­ (Chap4ta enrd5s ) a ndf uees seonfcs ee lf-management sagient hper eftaoct hefe i resdti ttihoenr,e cfoourled,s tratewgiitaeh fs o cuosnc ompliaennchea ncement bea ppltioec do ntemporary phpyrsaicotitinhc eear nadbp eyh aviocuhraanl(g Aep pen2d)iA.xp pend1ii xs 200R5e.a idat n ds ee. precebdyea dr evioeftw o piicsaslui ents h dee finition 'ThMea itlCaonndc eapsti h'ta, cs o mteo kbneo wn,o fR ]t,h ed efiniotfgi roand oefsm obilizaantdi on appeatrobs e c ontradeixchtiobriy,bt oittnhhg qe u alim­anipulaatnidto hrnee, l iaobfid leitteyca tnidrn egp re­ tioefss tabialnidft lye xi.Tb hielc iltiynbiacsaailns dt he sentitnhgep arameteenrcso untdeurreidpn ags sive Concepftu'nsd ameenlteamle hnatvsre e maintehde movemetnets ting. samteh rougihtoesuv to lutAitto hnse.a mtei mieht a s Ab ulletm-eptohioonfdpt r esentthitene xghta b se en changweidt thh et imeasn da ccepctoendt emporuasreyfd o crl araintdty oi mprotvheue s er-frieonfd liness manipulative phmyestihootdThshe.erC aopnyc eptt hbeo okT.h el inder awisnoge sx perptrloyd ucbeyd hams aintaainnu enda ssumnionng-,j udgeamnedn tAanln Mea itlhaanvdbe e esnu persbeydp ehdo tographs. open-mianpdperdo awchhi,cp he rpetuaa ptaetsi enTth­em airne asfoontr lU iss t oc omplemtehnCetD -ROM centmroedde olfc linpircaaclt Tihciiessi. t bsa ckbonweh icahc compatnhiiefsso urefdui tainodnh elptso andt hset rensgttal1b,ia lnidft lye xiobfi lstiyhtmeyb olibcr ingl imtfooes otft htee chnioqfeu xeasm inaatnido n permea'bblrewi aclkal n'a glyo. treatdmeesnctr iinbt ehbdeo ok. Thef ouretdhi toifMo ani tlaPnedr'isp hMearnaiLp ula­ KeviBna nkesx prehsistseh sa ntkosJ: u kkKaa ngas tiopnr eseannit nst egrcaotnetde,m paonrdae rvyi dencaen­dD onnAar drfoontr h eciorn struccotmimveeno tns basemdo deolf m anipulpahtyisvieo atphySe.ur cah ther evisteedxR to;b iBnl akfeo srh arihnigks n owl­ modeilsp lacweidt htihnce o ntoefx' tb epsrta ctfiocre e'd gaen de xperotviesmrea nyy earasn,dN ancayn d movement-related neurdoimsuosrcdoufel rosts hkkeie dlfseott rha eli r patuinednecres taanindnsd eienign g thuep pearn dl owelri mEba.c chh apotfet rh is textth iphsra osj tehcrto ugh. beerne visaendde xpandteodr eflaedcvta nciens EllHye ngevweilsdh teots h anekv erybwohdohy a s knowleadngde them raonliepu olpfah tyisvieo thergaipvyec no nstructive tsotu hgtege exsittnspi ,ao rntsi cu­ withcionn tempocrlairnypi rcaaclt Tihcieis.n cludelsaR:re nedeeR uyter-BoaunwdHm uang oS tamG;is ela three ferteont cheIen ternatCiloansasli ficoafFt uinocn­ Rolafs,a teachientr h e1 980fso,hr e rd edication, tioning, DiasnadHb eiaLlit(thir eCsWF H,O 2001p)a;i n thoroughannedds est ermintaogt iivoeenv erything mechanibsimosp;s ychopsaroacdiiatglhm rese ;h abilfio­hre rv isioFnrsa;na znidU elCia,t herCihnrei,s tin tatiporno caensdcs u rrdeenfti niatniddo enssc riptainondRs o lanRde,n eaen dH enk-t hanfkosbr e insgu ch