Maitland's Vertebral Manipulation, ed 6.

Maitland's Vertebral Manipulation, ed 6 Maitland GD, Hengeveld E, Banks K, English K, eds. Woburn, MA 01801, Butterworth-Heinemann Inc, 2001, paperback, 488 pp, illus, ISBN: 0-7506-2447-7, $80.

The sixth edition of Geoffrey Maitland's Vertebral Manipulation retains all of the good points of the fifth edition and adds several new features, including a brief biography of Maitland. The biography highlights his involvement in the historical development of physical therapy and manual physical therapy in particular. The biography is written by the 3 new editors of this edition: Elly Hengeveld, Kay English, and Kevin Banks. The glossary has been expanded to 2 1/2 pages and includes new definitions for terms such as "neural movements" and "severity." There is a new chapter on prognosis, and a new chapter on veterinary physical therapy. Sixteen new illustrations also have been added.

Throughout the text, colored highlights are used to emphasize key points. Frequently, short summaries of major ideas are presented in boxes interspersed in the text. The sixth edition contains mostly minor revisions of the fifth edition, and these revisions are occasionally supplemented by new material. Some chapters have been reordered to improve the flow of ideas. In chapter 1, "Introduction," small changes have helped to better emphasize the importance of a thoughtful approach to the patient and enhance the reader's understanding of this concept, which Maitland has championed. The text of chapter 2, "The Doctor's Role in Diagnosis and Prescribing Vertebral Manipulation," remains virtually unchanged. In chapter 3, "Communication," the text has been freshened and slightly expanded to improve understanding of the key concepts. Chapter 4, "Assessment," has been moved from its previous position as chapter 8 in the fifth edition, and it now precedes the new chapter 5, "Prognosis."

In chapter 5, the basic ingredients of prognosis are outlined: diagnosis, structure at fault, and nature of injury (ie, onset, stage of healing, reactivity, previous history, age, general health, sex, occupation, and, importantly, the influence of treatment). In particular, the authors acknowledge that, although the immediate "cause" of symptoms, such as a hypermobile joint, may be readily determined, the "source" of the "cause," such as muscle imbalance or hypomobility in a related location, should be sought in order to refine the prognosis. The authors then discuss particular clinical prognostic indicators in specific regions of the spine. Several references are provided; however, this chapter appears to be drawn largely from the authors' clinical experience, which is amply illustrated with patient examples.

Chapter 6, "Examination," which was chapter 4 in the previous edition, has been expanded from 60 pages to 74 pages to reflect the importance of this component of patient care. The expansion appears seamless and provides an opportunity to include additional information that is primarily focused on the examination, emphasizing how the experienced clinician generates and tests hypotheses. There also is an expanded section on palpation and its use in examination and a brief new section on "neural linked movements." At the end of the chapter, there is a new brief overview that outlines the recommended steps of the examination. Chapter 7, "Principles of Techniques," formerly chapter 5, includes a new illustration of the 4 thumb contact points that Maitland recommends for delivering vertebral pressures and an expanded section on mobilization, which discusses patient responses in more detail and adds specific advice for optimizing treatment effectiveness. Chapter 8, "Selection of Techniques," formerly chapter 7, and chapter 9, "Application of Techniques," formerly chapter 6, have undergone only minor changes.

Chapter 10, "Cervical Spine," formerly chapter 9, has been reorganized to improve its clarity, and some illustrations have been added to further elucidate the generously described examination and treatment techniques. Chapter 11, "Thoracic Spine," has been increased from 26 pages to 33 pages, and the new material is largely devoted to the differential diagnosis of thoracic disorders, with a welcome reminder of the visceral and sympathetic relations in this region. Chapter 12, "Lumbar Spine," has been expanded by 4 pages, and some of that increase also is devoted to differential diagnosis. A new technique, accessory movement in flexion, also is introduced. Chapter 13, "Sacroiliac Region: Sacroiliac Joint, Symphysis Pubis," has been expanded from 4 to 9 pages. The chapter contains a new case study and 3 additional treatment techniques for the symphysis pubis, including new illustrations. Chapters 14, "Sacrococcygeal and Intercoccygeal Regions," and 15, "Examples of Treatment," are largely unchanged.

Chapter 16, "Physiotherapy for Animals," is entirely new and is largely confined to equine therapy. It is unclear who has actually written the chapter; however, the focus is clearly on the work of TJ Ahern, an equine veterinarian who makes a significant contribution to the chapter. The main themes are that (1) physical therapists need no additional training to perform animal physiotherapy, (2) the principles of neural tension mobilization and joint mobilization can be applied to animals, and (3) cervical manipulation under anesthesia is effective for curing idiopathic lameness in horses.

The very useful appendixes 1 through 4 are largely unchanged. The epilogue from the fifth edition--which admonished readers to think of the "Maitland concept," but to remember that there are no "Maitland techniques," because techniques, being the product of the interaction of patient and therapist, belong to the therapist who performs them--is gone.

Although I can find no compelling rationale for removing the epilogue or for including the new (and limited) chapter on animal physiotherapy in this book, the majority of the changes to the new edition of Maitland's seminal text have been made in an appropriately circumspect fashion. The strengths of the text have been preserved, and in some cases enhanced, by reordering some chapters and reorganizing the original text. Congratulations to all the coauthors, who have helped to make this great text even more useful to physical therapists everywhere.

Roy Bechtel, PT, PhD University of Maryland Baltimore, Md

Dr Bechtel is Assistant Professor of Physical Therapy. He teaches courses on biomechanics and spinal orthopedics.