Introduction
The 40th anniversary of the Nederlandse Vereniging voor Manuele Therapie (NVMT) in 2021 was a trigger for this historical review by Huub Vossen and Anton de Wijer. Their writings were translated to English via an online translation application and edited by Glenn Ruscoe.
The genesis of manual therapy
As the founder of Western medicine, Hippocrates (400 BC) is one of the first sources for manual therapy. With him we find the earliest described example of spinal manipulation, including traction on the head and feet. The later Greco-Roman physician Claudius Galenus (200 AD) described manipulations of the intervertebral disc under traction.
Manual treatments were not only used in ancient Greece. For example, spinal manipulations have traditionally been widely practiced in Indonesia, Hawaii, Mexico, Japan, China, India, Central Asia and Mexico, among others. In his Textbook of Orthopedic Medicine, London orthopaedist James Cyriax claims that spinal manipulation may have been practiced in Thailand as early as 4,000 years ago. Apparently applications of manual actions for complaints of the musculoskeletal system are as old as mankind.
Bonesetters
In literature from the eighteenth and nineteenth centuries we come across the so-called ‘bonesetters’, described as ‘practitioners of joint manipulation’ as well as reducing joint dislocations and resetting bone fractures. Traditionally, they practiced their profession without any formal medical training.
Anderson (1992) considers the bonesetters as precursors of today’s manual therapists and chiropractors, referring to the bonesetters from Nepal, Russia and Norway.
Different Currents
In the course of the nineteenth century, different movements arose in manual therapy. This was mainly due to the fact that different views arose on the disorders and their treatment with the age-old manual techniques. This is how osteopathy (according to Andrew Still’s vision) and chiropractic (according to Daniel Palmer) arose in America. Osteopathy was mainly based on influencing the ‘visceral system’ while chiropractic worked more from influencing the ‘musculoskeletal system’. The latter is actually most closely related to current manual therapy. After 1900, names like the British John Mennell and James Cyriax, and the French Robert Maigne, further systematically developed manual therapy.
In 1950, Freddy Kaltenborn, who had been trained by Cyriax and Mennell, initiated the first manual therapy course for physiotherapists in Norway. In Australia, Geoffrey Maitland became famous for ‘Manual Therapy according to the Maitland Concept’.
The emergence of manual therapy in Europe
The emergence of manual therapy, osteopathy and chiropractic in Europe was a reaction to conventional medicine at the time. A physician was defined in the early nineteenth century as ‘a scholar without practical training, whose profession was sad and which required great courage and affection in order to practice it’. (T. Terlouw, 2010). The usual treatment methods at that time were: bloodletting, purging, administering medicines and operating without anaesthesia with a very high mortality. From this context we can now better understand why the ‘natural scientific method’ gained ground and the ‘manually trained’ eventually gained more and more prestige, also among medical practitioners, who often admired their skills. So there was also a need for progress in medicine, but what had to change? The ‘French Clinic’ took the lead in the turnaround in Europe by emphasising the importance of direct clinical experience in the training of the physician, partly because scientific theoretical substantiation alone was not sufficient to be a good physician, the then opinion of trainers in France. It is quite possible that the more practically trained healers gained prestige with their skills through this emerging vision in medicine, thought the trainers in France at the time.
Yet these new movements in manual therapy were also a target of criticism among physicians. They lumped remedial gymnasts, osteopaths and chiropractors together with the practitioners of alternative medicine (quackery) such as homeopathy and naturopathy, who were also emerging in the nineteenth century. The implausible claims of the curative effect of their method, which clashed with the dogmatic thinking in the training courses of the time, were rejected by the doctors. Another issue was that these new professionals were entering a competitive market. The treatment of the spine and other parts of the musculoskeletal system was explicitly included in the domain of medicine (orthopaedics). The battle between remedial gymnasts and doctors was fought in various places in Europe and certainly also in the Netherlands. Nevertheless, the rise of manual therapy continued worldwide. For example, the interest in manual therapy among remedial gymnasts in Europe was stimulated by colleagues who had followed training in America. Particularly due to the positive treatment results of patients who had been treated with manual therapy abroad, interest and with it the number of healthcare professionals grew. However, it would take until the end of the nineteenth century for manual therapy to gain a permanent place in Europe.
The history of the forerunner of manual therapy in the Netherlands
We also knew bonesetters in the Netherlands. They were already active on a large scale in the seventeenth century in the North Holland town of Jisp, which thanks to its maritime background managed to attract many visitors because at the time, due to the open connection to the Zuiderzee, it was an important port for whaling and herring fishing.
In this context, we can regard the bonesetters in Jisp as the precursor manual therapists in the Netherlands. The birthplace of manual therapy in the Netherlands was in fact in this North Holland town, which at the time was known for its renowned limb setters who treated lameness, dislocations after fractures and mutilations.
Mr Cornelus Jacobsz Ploegh (1624-1696) was the most famous bonesetter, because he was also Mayor of Jisp. Several names appear in the cemetery of Jisp, such as Thaemszoon de Leedsetter (died March 29, 1606), Willem Thaemszoon (died February 24, 1644) and Jacob Ploegh (1657-1692). They were renowned far beyond our borders. The practice house was known as the ‘Verbandstukje’.
The emergence of manual therapy in the Netherlands in the twentieth century
The forms of manual therapy that we now know in the Netherlands were introduced in the early twentieth century. In the period 1945-1981, the first articles appeared in the Dutch Journal of Medicine (NTvG) about osteopathy, chiropractic and manual therapy.
The first manual therapy course in the Netherlands was founded in 1964 by G van der Bijl Sr. (1909-1977) in Utrecht, followed in 1967 by the Manual Medicine Foundation (SMG) in Eindhoven. This last initiative came about on the recommendation of Dr Ir FJ Philips who, during his stay in New Zealand, suffered from back problems that were successfully treated with manual therapy.
Both programs went through their own developments, whereby the vision did not always run parallel. Who doesn’t know them… the Method Eindhoven and Utrecht, the Maitland Concept, the Method Cyriax and Marsman, etc. A colourful collection of methods. How was a patient or referrer supposed to become aware of this? These differing views often led to conflicts over which ‘taste in manual therapy’ should be recognised and to discussions about whether or not the vertebra should ‘crack’ during a manipulation. The word ‘bone cracker’ had been used since ancient times and the phrase ‘for every crack a crack’ was often considered appropriate. The most important similarity between all those methods was the enormous substantive drive and passion that the manual therapists showed, among other things, in the teacher departments that had arisen. This passion eventually led to the foundation of the first Manual Therapy Association (VMT) in 1968 and later, in 1978, to the recognition by the Royal Dutch Society for Physiotherapy (KNGF) of manual therapy as a specialisation within physiotherapy. A few years later, in 1982, the Dutch Association for Manual Therapy (NVMT) was founded and in 1991, the Dutch Association for Orthopaedic Manual Therapy (NAOMT).
The different movements in manual therapy in the Netherlands ensured that the profession never became boring. There was always something to discuss and perhaps that diversity has accelerated the call for further scientific substantiation. Rob Oostendorp was the first manual therapist in the Netherlands to obtain his PhD in the field in Nijmegen (1988) with his dissertation entitled: Functional Vertebrobasilar Insufficiency.
Oostendorp later became professor of manual therapy at the Vrije Universiteit Brussel (VUB).Under the influence of Rob Oostendorp, Nol Bernards and Leo Hagenaars, the neurophysiological factors were further elaborated in the eighties, which led to the multidimensional load and load capacity model. Rector Magnificus of the UVA, Prof Dr Lex Bouter, praised at the farewell jubilee of Prof Dr Rob Oostendorp that manual therapists have become pioneers within the professional group of physiotherapists by being the first to put science on the NVMT’s administrative agenda.
Experts from the medical specialties in the field of the spine were also brought into the Manual Therapy courses.
Prof Henk van Mameren, anatomist and lecturer at SOMT, praised the pioneers in manual therapy at the time for their enormous passion and knowledge of the anatomy, kinetics and pathophysiology of the spine. Thanks to the many inspired pioneers we have had in our field, physiotherapy students can now follow a master’s degree in manual therapy.
On 20 June 1979, the Board of the Royal Dutch Society decided for Physiotherapy to recognise manual therapy as specialisation within physiotherapy. Not long afterwards, on 23 March 1981, the Dutch Association for Manual Therapy (NVMT) was founded in Zeist, with the main objective of promoting manual therapy as a specialty of physiotherapy.
Manual therapy in the Netherlands has since made a huge advance and gained a lot of influence. Also abroad, all developments in the Netherlands did not go unnoticed, which meant that the NVMT was able to bring the famous international ‘IFOMPT conference’ to Rotterdam.
The future of manual therapy
From a historical perspective, manual therapists are relatively newcomers in healthcare in the Netherlands. Especially when we realise that the KNGF, with the Association for Remedial Gymnastics as its predecessor, has existed for more than 100 years.
With the development of the master’s programs and the development of science in the Netherlands, the differences in vision between the various movements in manual therapy have faded into the background and the hatchet was buried. As a result, the manual therapy profession has matured and in that light the criticism of the dogmatic physicians of 150 years ago was perhaps justified. They looked at these new methods in the field of medicine from a scientific perspective. Let us therefore hope that the course ‘History of Manual Therapy’ will also be introduced within the current master’s programs in the Netherlands so that students can learn the wise lessons, which are the history of manual therapy has to offer us.
In recent decades, terminology and domain delineation have been discussed and clarified. There are still different answers to the question what manual therapy is in the literature. Initially, the approach was condition-specific. In the meantime, the therapy has become more patient-oriented and has managed to develop in breadth, making use of the domains of psychology and sociology, so that concepts such as pain modulation and management are now more prominent. The manual therapist has, through his physical approach combined with strongly increased communication skills aimed at behavioural modification and lifestyle, acquired a correct position in current patient-oriented care.
The NVMT has reached a milestone and can be proud that a lot of good has been achieved in a short time.We look back with pride on the glorious past of manual therapy, which has managed to acquire a prominent position in healthcare.
References
- Claudius Galen.https://nl.wikipedia.org/wiki/Claudius_Galenus
- Bonesetters.https://en.wikipedia.org/wiki/Bonesetter
- Terlouw TJA The last word has certainly not yet been said about ‘manipulation therapy’. Introduction to the history of manual therapy in the Netherlands. 20/10 Publishers. (2011)
- Terlouw TJA The rise and fall of the Zander Institutes around 1900 in the Netherlands Gewina 27 (2004) 135-158.
- Terlouw TJA The emergence of the remedial gymnastics profession in the Netherlands in the 19th century. About rare amphibians in a frogland. Royal Library, The Hague. pp. 260, 261, 168. (1991)
- Leijssenaar B. Physiotherapy in the Netherlands. 1965-present. KNGF, Amersfoort. (2011)
- Foundation History of Physiotherapy (SGF), Drs. W. Schoenmans, physiotherapist, philosopher. Urk.
