A brief history of the NZ Manipulative Physiotherapy Association

In August 2009, members of the New Zealand Manipulative Physiotherapy Association met in Rotorua to celebrate 40 years of the Association.  A commemorative booklet was produced as part of that celebration.  The following summary history formed part of the text.  

The New Zealand Manipulative Therapists Association (NZMTA) – the original name given to the Association – has its roots in manipulative practices that stretch back to man’s earliest attempts to “set” joints.  In early civilisation through Hippocrates (460-355 BC), Appolonius of Cyprus (60-80 AD), and Persian Scholar Abu Ali Ibn Sinna (980-1037 AD); through the Middle Ages and the Renaissance with European surgeons Guido Guidi (1500-1569) and Ambrose Paré (1510-1590); to practices that emerged in India, China, Africa and the Pacific Islands for bonesetting, realignment of joints and mobilisation of tissues.  Today’s manipulators, however, draw their inspiration from some of the early pioneers of scientific manipulation: people like Andrew Still - the first osteopath, Edgar and James Cyriax, and James and John Mennell.  These frontiersmen provided the inspiration for our own leaders –  people like Stanley Paris Jr., Robin McKenzie and Brian Mulligan – to develop their own approaches to manipulation and mobilisation, and take their practices around the world. 

The origins of the NZMTA can be traced to the use of manual therapies in the first half of the twentieth century.  The rehabilitation of returned servicemen, farm workers, sportsmen and people with scoliosis, fractures, dislocations and for those recovering from surgical joint repair, aroused particular interest in a small number of medical practitioners and physiotherapists.  In 1950, John Mennell visited New Zealand to be followed by one of James Cyriax’s physiotherapists - Jennifer Hickling - in 1954.  These visits were pivotal in showing a small group of young physiotherapists that there were techniques to be learnt and practices to be studied overseas.  One such therapist, Stanley Paris, left New Zealand to travel to Europe to learn Cyriax’s methods and those of Alan Stoddard, Gregory Grieve and Freddy Kaltenborn in Norway.  On his return to New Zealand in 1964, Paris began teaching these techniques to New Zealand physiotherapists, and the process of formalising a group dedicated to the study of manipulations began.

In the period immediately after Paris’s return, a group of Wellington private practitioners began meeting to share techniques.  Craig Cameron, Rob McKenzie, Brian Mulligan and Michael Monaghan organising the first meeting of 22 manipulative practitioners in November 1968.  At the first meeting, the aims and goals of the group were set out as follows:

• To participate in the formation of an Australasian association of manipulative therapists
• To foster and promote the use of joint manipulation
• To interest and encourage the medical profession to avail themselves of the skills of the members of this association
• To further the education of the association’s members in the field of joint manipulation
• To arrange conferences, courses, demonstrations and to otherwise disseminate knowledge
• To establish liaison with groups or individuals in other countries who have similar interests
• In tracing the history of the NZMTA it is interesting to see how the pursuit of these aims has marked out much of the Association’s history. 

The early years of the Association were dominated by the need to establish a formal qualification in manipulation.  Under the guidance of Brian Mulligan, a two-year long manipulations course was created, with the first graduates (Almao, Buswell, Clague, Drury, Gilberd, Hood, Ingram, Neame, R. McKenzie, Mulligan, Searle, and Sim) completing in 1973.  At the same time, the issue of international linkage and standardisation of practice became critically important.  Because of a French government ban on manipulations in the late 1960s, Norwegian Freddy Kaltenborn had begun a campaign to form an international association of manipulators to promote their practices, and to ensure the quality of standards among participating nations.  Because of New Zealand’s strong association with Kaltenborn, it was natural that New Zealand-based practitioners would participate in the first month-long course run by what would become known as the International Federation of Orthopaedic Manipulative Therapists (IFOMT) in the European summer of 1972.  At its first formal meeting, Ian Searle was nominated onto the Executive of the body beginning nearly 40 years of continuous service to IFOMT Executive from New Zealand members. 

Educational visits from Kaltenborn (1969) and James Cyriax (1970), and overseas excursions by Robin McKenzie and Brian Mulligan began to build New Zealand’s level of expertise and international influence, and New Zealand was accepted as one of only six full member of IFOMT at its first seminar in Gran Canaria in 1973.  At the meeting - which was run as a month long course - some of the most well known manipulators attended, including Gregory Grieve, Geoff Maitland, Alan Stoddard and Freddy Kaltenborn.  IFOMT was instrumental in establishing international standards for manipulative practice, and while New Zealand met the standard of membership, the question of uniformity and quality of practice, protection of speciality, and the continuing education of manipulative therapists was an important concern for the early NZMTA membership.

With IFOMT defining standards for manipulative therapists, the NZMTA could concentrate its attention on its education programme.  The cornerstone of which was the Diploma in Manual Therapy (DipMT).  At its inception, the diploma was not a recognised higher education qualification, but the NZTMA was able to issue certificates to its graduates.  Repeated attempts were made to secure special status for those who had passed the diploma.  In the years prior to the formation of the Accident Compensation Commission (ACC), for instance, attempts were made to give those with the diploma special status and remuneration within the public health system, whilst at the same time, attempting to become the principal providers of manipulative therapy to those within orthodox health care.  As Robin McKenzie argued in his President’s Report of 1970; ‘We can look forward to the time when the medical profession will turn to members of this Association for assistance in the treatment of all suitable spinal conditions and conditions affecting the extremity joints.’ 

This concern to promote the quality and capabilities of its members led the NZMTA into a lengthy and costly dispute in 1978 with the Commission of Inquiry into Chiropractic.  After numerous attempts by the chiropractic profession in New Zealand to gain official recognition for itself, an official inquiry was launched into the financial support, education and training, and scope of chiropractic.  Spearheaded by Ace Neame (President of NZMTA) and Don McKenzie (President of NZPPA), the two associations organised a concerted campaign alongside the NZSP, lobbying against the claims made by the chiropractic community.  Supported by the New Zealand Medical Association, the Commission came out in favour of greater recognition of chiropractic, but demanded higher standards of education, practice and reporting.  What became abundantly clear for the NZMTA, however, was that manipulative therapists in New Zealand could not rest on their laurels, and that research would be needed if the Association was to continue to promote the profession. 

Whilst the DipMT had provided a strong foundation in practice skills (running now over two years with both extensive extremity and spinal manipulatio

Correction of the lateral shift, from McKenzie R (1981)

n components), the Association had long recognised the need to develop closer links with the two physiotherapy schools - not least because there was a desire to see manipulative therapy teaching enhanced in the undergraduate curriculum.  In 1976, for instance, the NZMTA’s Executive sought ‘...to explore all avenues and possibilities of a course to be held in conjunction with the Auckland Technical Institute.’  In the same year, the Association offered to ‘help’ the Dunedin School appoint suitably qualified teacher by ‘supplying lists of graduates’ from NZMTA course, and asking that ‘wherever possible suitable Association teachers make their services available to the school as required, part time.’  The desire to influence formal education culminated in the late 1980s with moves to build a reciprocal relationship between the DipMT with Auckland Institute of Technology’s Advanced Diploma in Manual Therapy.  Both of these courses, in addition to Otago’s postgraduate manipulative programme, met the standards required by IFOMT and there was a palpable sense that some rationalisation in the education marketplace was needed.  All three programmes now met with New Zealand Qualifications Authority (NZQA) approval, and so discussions began to develop a Graduate Diploma in Health Sciences as a collaboration between AIT and NZMTA.  Collaboration continued through the 1990s with the DipMT students involved in clinical supervision of AIT students, and sharing the teaching load.  By the end of the millennium, both schools of physiotherapy had developed Masters pathways for musculoskeletal practitioners, and the need for greater research and evidence-based practice saw the demise of the DipMT in 2003.

If the NZMTA reached maturity as an organisation with the Chiropractic Inquiry, it established its professional niche with the advent of ACC in 1973.  Prior to ACC, physiotherapists in New Zealand worked predominantly in the public health system, and the protection that this gave meant that early NZMTA members’ primary concerns were to secure special status for their graduates (including remuneration and special recognition), and a close affiliation with the medical profession.  With the advent of ACC, a number of new opportunities emerged, but at the same time a marketplace opened up where there was greater competition from other, less well established professions.  Early in the life of the ACC, the NZMTA complained about ‘The undue and unnecessary delays from the time a patient injures his back until the time he sees his medical practitioner,’ and the ‘Undue and unnecessary delay in the time the patient is referred for treatment for this condition.’  They also argued that ‘...the patient is victimised financially in regards to the payment of fee when he attends for treatment before he can obtain medical certificates.’  A concern to ensure patients had ready access to NZMPA members led the Executive to issue Best Practice Guidelines for an ACC taskforce in 1997 as a way of validating its skills and demonstrating its efficacy. 

Throughout its illustrious forty-year history, the NZMPA has nurtured manipulative therapy and supported its therapists in a most professional, proficient manner.  It has been supported throughout by dedicated, selfless individuals who have given their professional lives, in some cases, to furthering the science and practice of manipulative therapy.  Careers of world-renowned practitioners have blossomed under the watchful eye of the membership and many innovations and ideas have been tested in the pursuit of manipulative excellence.  It is fitting that on this 40th anniversary of its founding, we pay tribute to the Association and all it has done for physiotherapy in New Zealand and around the world.

By David Nicholls