Level 2b, Maitland week 7

Level 2b started in Warsaw in the second week of May. I had almost no other knowledge of what the schedule would hold expect cervical instability and manipulations. As usual, Thomas was teaching and Daria was translating and basically being there for practical help also. The second teacher was Stefan Schiller. 

I had never been to Warsaw so I was looking forward for that also.

Manips. The single word that holds so much thoughts, feelings of relief, fear, expectations, myths and most of all: the divine crack that can feel like the original problem went away at the same heart beat.

I started this journey over two years ago. I knew that one day I would have completely different knowledge level of musculoskeletal physiotherapy, a new title and be the one who could do manips. 

I am not sure whether I can explain this correctly… I myself don’t see any manual technique what so ever being the best of the best or if it would be cool to hear random cracks from the spine. There is so much misknowledge about the subject that I am not going there.
I rather value higher up the level of knowledge in where one is to perform the manip safely. In the course we spent at least three times more time of practicing the safety tests before we whether do the manip or not. In the first day of practicing I didn’t want to try the manipulation of cervical spine and I didn’t want anybody to do it on me. I wanted to feel relaxed and have a good over all feel with different kind of necks before doing it.


Everybody could of course decline if they didn’t want any manips to be done to them. Last autumn I was in a different concepts course where we practiced a lot of different kind of manual treatments. I had been treated with the same technique at least dozens of times by my trusted colleague and everything had gone without any bigger side effects. During the couple of months before the course I had too many things on my plate in a too little time so my body and mind where in totally not well recovered stage. The practice treatment I was given made me stay in bed for two total days and I was unable to go to work in four days because of dizziness and nausea. The symptoms went away after two weeks.

After that I have been more reserved about how much of practice treatments I can take.

Anyhow, I rate higher the knowledge of when the manipulation would be helpful and which things should be considered before performing it safely. Not like placing your fist between the patient’s spine and the plinth and then jumping on the patient and giving the sudden relief on cracking sound. That is why I waited the highest grade in mobilizations: to get on higher level of my personal skills and after that getting a new tool in the tool box

Other cool stuff was definitely the pain lectures. I am currently also taking this one-year lasting pain course which is being organized in my home town. It was super interesting to follow to Stefan’s lectures which went together pretty well with the pain course stuff. Pain as a subject can be and often is a very complicated mechanism so I don’t see how anyone could have a too good of an understanding about that. 

So, what can I say. As the weeks have passed by, the stuff has gotten better and better. 

It is funny though how the old mindset can keep on coming back to your thoughts. I got a good example of this again on this week when I was bouncing around the question about the structures and possible specific damages regarding on painful movement on a shoulder. This was with the demo patient who was kind and let me take some pictures of her.


If the painful or restricted movement is easily known, it is of course important to know the structural stuff in that area. But it is necessary to know which possible structures are responsible for i.ex. the pain? At this point I had a clue what Stefan would answer: the structural damage does correlate with pain very, very poorly. And when I asked the question because I wanted some reassurance for the thoughts, he replied exactly like that. He also added that if there was some bigger tissue damage, we as physios could not do much about it. That is why surgeons are for.

Well that’s true.

What we can do instead is operate with the movement and muscle strength. When the symptomatic movements are known, it is only matter of imagination and theoretical knowledge of what stuff you can do with that info. 

I am not someone who follows every physio Twitter account or subscribes studies every week. Still even I know that building muscle strength has been a rising trend with pain management. There are quite few things that can be proven to have a pain decreasing effect and exercising in its different modes is definitely a one of them. That’s why it was pretty cool to follow a different kind of demo patient in this week. She had hardly any so-called traditional hands on manual therapy.

We also did a lot of exercise training concerning neck instability. The instable cervical spine was included to different treatments and examination techniques of thoracic spine and there was a good chance to revise of the PPIVMS (passive physiological intervertebral movements, a word monster) as well.

I mentioned on the 6th weeks blog that I was expecting some Finnish invasion for this level. And oh yes, there was in total seven of us from the North. It was nice to hear how they had done certain things in courses in Lahti. The concept is international but every teacher brings to it one’s own perspective. Some things were obviously different, like patient cases with different language and possible language barriers with fellow course mates. But somehow it is always manageable and the language skills are taken in account by the teachers.



For the first time I included some actual holiday within the travel to Poland. On the last short day of the course I did catch a train to Krakow. There I spent one day in a place I just knew I should visit.

It was funny to see how different the mode was when the course was over. The weeks are quite intensive and no matter how beautiful the city is, I am on a sort of study settings and it is hard to focus on purely for the travelling. Less than in a couple of days it is possible to go out of that zone and see the new places in totally different way.  

Let see what the week 8 holds on September. Thanks again for the whole group!

Now it is good to be home.

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