Professor Chris McCarthy
PGD Physio, PGD Biomech,
PGD Manip Ther, PhD, FCSP, FMACP
Professor Chris McCarthy is a Clinical Academic Fellow, Adjunct Professor and former
NHS Consultant Physiotherapist at Imperial College, now leading the
Manchester Movement Unit of the faculty of Health Professions,
Manchester Metropolitan University, United Kingdom.
Chris’s book “COMBINED MOVEMENT Theory: Rational Mobilisation and Manipulation of the Vertebral Column has sold worldwide, since 2010. In addition, he is one of the contributing authors and editors of the recently published
Grieve’s Modern Musculoskeletal Physiotherapy (2015 and 5th Ed 2024).
What is Combined Movement Theory
Combined Movement Theory is the development of Dr Brian Edward’s “Combined Movements” to rationally incorporate Spinal Manipulation Techniques, Muscle Energy Techniques and new methods of Mobilisation. The concept promotes rational Manual Therapy for Spinal Dysfunction.
To move is to change place, position or posture. Thus, the positions at the initiation and cessation of movement are integral to the analysis of movement. Combined Movement Theory (CMT) offers the investigator a framework to examine the influence of starting and finishing positions on movement impairment and use these positions to intervene therapeutically.
COMBINED MOVEMENT Theory: A Unique Approach to Spinal Manual Therapy
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.
This three-dimensional approach allows practitioners to identify specific "quadrants of dysfunction" - or "quadrants of threat" and "directional sensitivity" to movement.
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.
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.
