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COMBINED MOVEMENT                 Theory

COMBINED MOVEMENT Theory: A Unique Approach to Spinal Manual Therapy

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Combined Movement Theory (CMT), developed by Dr. Brian Edwards and further refined by Dr. Chris McCarthy, represents a paradigm shift in manual therapy by focusing on the critical importance of starting and finishing positions during spinal treatment. Unlike traditional manual therapy approaches that typically examine and treat spinal movements in isolation, CMT recognizes that spinal dysfunction rarely occurs in single planes of movement. Instead, it systematically analyzes how combining movements in multiple directions (flexion/extension, lateral flexion, and rotation) can both reveal the true nature of dysfunction and provide more effective treatment pathways.

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This three-dimensional approach allows practitioners to identify specific "quadrants of dysfunction" - or "quadrants of threat" and "directional sensitivity" to movement.

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What makes CMT particularly unique is its rational, systematic framework for integrating different manual therapy techniques based on clinical presentation rather than adhering to a single treatment philosophy.

 

The approach seamlessly incorporates Grade IV- and IV+ mobilizations, spinal manipulative thrust techniques (SMTT), muscle energy techniques, and proprioceptive neuromuscular facilitation within a unified theoretical framework.

 

Practitioners use a distinctive notation system and "box diagrams" to document movement patterns, which helps determine whether a patient has an anterior or posterior stretch dysfunction and guides the selection of appropriate starting positions for treatment. This ensures that the most provocative combined movement position becomes the optimal treatment position.

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The clinical reasoning process embedded in CMT sets it apart from technique-focused approaches. Rather than teaching practitioners a set of manipulative techniques to apply broadly, CMT emphasizes understanding when, where, how, and why to apply specific interventions. The method teaches practitioners to recognize which patient presentations are suited to this approach, how to progress or regress treatment based on response, and when to integrate manipulation versus mobilization.

 

This evidence-based framework, supported by extensive research and clinical validation, transforms manual therapy from a collection of techniques into a comprehensive clinical reasoning system that consistently delivers excellent outcomes for spinal dysfunction.