We have all been in the situation where a patient presents to us with severe pain and impaired motion in a particular direction. We want to relieve their pain but don't want to do too much treatment and make them feel worse. Combined Movement Theory (CMT) is an examination and treatment framework incorporating spinal manipulation techniques, muscle energy techniques and mobilisation. Patients are placed in comfortable positions and moved in a manner that evokes a brain orchestrated pain inhibition mechanism, quickly. Patients learn that the threat they perceived, with a particular motion, can be simply reduced with movement. Now that we understand the neurophysiological effects of Dr Brian Edwards’ ‘combined movements’, it is clinically reasonable and a valuable tool for anyone interested in addressing specific impairments with specific physical education (Manual Therapy). This article explains the essential elements of CMT, how to put theory into practice, how to incorporate mobilisation and manipulation, how to detect regular and irregular patterns of spinal movement, and finally how to progress treatments.
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Dr Chris McCarthy PhD, FCSP FMACP is a physiotherapist and clinical fellow at Manchester School of Physiotherapy, Manchester Metropolitan University. After qualifying as a physiotherapist in 1989 he undertook post-graduate training in Biomechanics and Manipulative Therapy at Strathclyde and Coventry Universities before undertaking a PhD degree in rehabilitation within the faculty of Medicine at Manchester University.
He teaches internationally on manual therapy and lectures on four of the Masters courses in Advanced Musculoskeletal Practice in the UK. He is a member of the international advisory board for Manual Therapy journal and regularly reviews and publishes papers in the academic field of manual therapy. He has been made an honorary fellow of both the Musculoskeletal Association of Chartered Physiotherapists and the Chartered Society of Physiotherapy for his contribution to the field of manual therapy.
Chris is author of Combined Movement Theory: Rational Mobilisation and Manipulation of the Vertebral Column as well as the chapter on ‘Manual Therapy and Pain’ for the second edition of Elsevier’s popular Pain: A Textbook for Therapists. In addition, he is one of the editors and contributors to the seminal Grieve’s Modern Manual Musculoskeletal Physiotherapy, 4th edition (2015).
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