International Federation of Orthopaedic Manipulative Therapists (IFMOT)

Manipulation is the cornerstone of contemporary physiotherapy in New Zealand.  It dominates our curricula, our postgraduate programmes, our funding sources, and our professional relationships.  Manipulation defines our professional identity, and it sets us apart from other physiotherapists around the world.  Whatever it is that makes a good manipulative physiotherapist, there seems to have been a lot of it around in the 1960s and 70s as pioneers like Stanley Paris, Ian Searle, Brian Mulligan, and Robin McKenzie established one of the most influential professional specialty organisations in the world of physiotherapy – IFOMT, the International Federation of Orthopaedic Manipulative Therapists.

The history of our present predilection with manipulation can probably be traced to a visit to New Zealand in the early 1950s by Jennifer Hickling, one of Cyriax’s English physiotherapists, when she presented a practical demonstration of Cyriax’s techniques with Brian Mulligan as a model.  Cyriax’s penchant for “agricultural” manipulation impressed Stanley Paris Snr who attended one of Miss Hickling’s demonstrations, but it was Stanley Paris Jnr’s decision to visit Europe and America which probably had the most enduring effect on the profession.

Having studied under Cyriax and Stoddard in England and Kaltenborn in Norway, Paris moved to Boston to set up a highly successful physiotherapy clinic.  In 1966, Stanley heard that Gregory Grieve was sponsoring an extended manipulations course in England to be run by Australia’s Geoffrey Maitland.  Stanley subsequently wrote to Grieve and Maitland to arrange a meeting and suggested that they should invite Kaltenborn to attend.  The two agreed to the meeting, but not including Kaltenborn.  Not to be put off, Stanley arranged for Kaltenborn to come and ‘coincidentally’ find himself in the same hospital canteen as Paris, Grieve and Maitland.  How Grieve and Maitland must have felt at being hijacked in this way is a mystery, but records show that a productive meeting took place (accompanied by the English physiotherapists Monica Martin Jones, Jennifer Hickling and Lois Dwyer, and Richard Williams from Australia), and at the meeting it was agreed that a committee should be formed to organise an international manipulative physiotherapists’ organisation to be proposed at the next WCPT meeting in Amsterdam in 1970.  Stanley Paris was nominated as Chair along with Robin McKenzie, and Hanna Thorsen of Denmark.

In Amsterdam, the creation of an international organisation was approved by seventeen delegates from eight countries, and it was agreed to launch IFOMT formally at the next WCPT meeting in Montreal in 1974.  At that meeting, twelve countries sent delegates and ten were made voting members: New Zealand, Australia, Netherlands, Norway, Sweden, UK, Canada, Denmark, Finland, South Africa, and USA.  But only the first six met the rigorous standards set up to define the quality of manipulative therapy in that country.  Stanley Paris drafted the first constitution and became the first Chairman.

IFOMT­ was formed as an international forum for the exchange of ideas and practices, and as a means for defining standards.  This became more and more pressing as chiropractors attempted to establish themselves as the only legitimate provider of manipulative therapies.  At the same time the French Government, at the behest of Robert Maigne, banned physiotherapists from doing manipulations; only allowing doctors to perform these “specialised” techniques. 

This, naturally, mortified physiotherapists in England, Netherlands, Germany and Denmark, who had now developed sophisticated treatment systems under Kaltenborn and Olaf Evjenth.

Standards were clearly needed if physiotherapists were to be able to compete with chiropractors and doctors of manipulative medicine, and so it was decided to run a month-long course for any physiotherapists from around the world who wished to study manipulative physiotherapy, and in July 1973, the first Canary Islands course was run. 

The list of those attending that first meeting reads like a who’s who of manipulative physiotherapy: Brodin, Cyriax, Frisch, Kaltenborn, Paris and Stoddard delivered papers and New Zealand sent seven delegates (supported by grants from the NZMTA): Margaret Almao, Laurie Geden, Malcolm Hood, Ace Neame, Doug Perry, Ian Searle, and an M. Humphries – a temporary visitor to New Zealand, resident in Wellington.   

All the Americans present were convinced of the importance of spinal flexion and sat slumped in chairs and with legs up on beds by the pool.  All the New Zealanders, who followed the hyper-extension work of McKenzie, sat like stair-rods – erect and alert throughout the whole month of the course.  Practical exams were sat and certificates awarded to the 76 attendees from 12 countries.

IFOMT was formally ratified at Montreal in 1974 and its standards were approved at WCPT in Tel Aviv in 1978.  In the same year, IFOMT became the first formally recognised subgroup of WCPT, at which point New Zealander Ian Searle was appointed its executive secretary and, later, the organisation’s first Honorary Life Member.  Other New Zealanders, including Barbara Hetherington have acted as the organisation’s vice president and secretary, and there has been a New Zealand physiotherapist on the Executive in every year since its inception.

There were other month-long courses; in Gran Canaria again in 1975 and then in Vail, Colorado in 1977, but in 1980 IFOMT came to Christchurch, and Ian Searle organised the programme.  Kaltenborn, Paris, McKenzie and Cyriax came, and Brian Mulligan even managed to arrange for Professors Janda and Schmidt to come from Czechoslovakia – no mean feat in dealing with communist Eastern Europe.  All the sessions were recorded, and Don McKenzie painstakingly compiled one of the most complete transcripts of expert practice ever produced.  Not surprisingly, the conference was a huge success, both professionally and financially; providing the basis for the NZMTA (now NZMPA) scholarship fund which continues to this day.

Often the purpose of history is to provide us with insights into the conditions that make the present possible.  This can be no more true than in the present practice of musculoskeletal physiotherapy, which owes so much to the diligence, determination and devotion of a small band of pioneering practitioners. 

Physiotherapists today would do well to acknowledge their work and use it as an inspiration for the future of the profession. 

By David Nicholls