Virginia Chiropractic Continuing Education

• Examine the effects of thoracic manipulation and non-thrust mobilization on pain sensitivity and intensity in patients with chronic mechanical neck pain
• Summarize the state of the literature on the utility of spinal manipulation for managing hypertension
• Critique a recent study on the importance of cavitation in the autonomic nervous system (ANS) effects of thoracic spinal manipulation
• Evaluate the scientific literature on the validity and reliability of the common methods used by chiropractors to inform the choice regarding where spinal manipulation is to be applied once it is deemed an appropriate treatment
• Explore biomechanical and neurophysiologic mechanisms of thoracic manipulation that might result in clinical benefit for patients with rotator cuff tendinopathy

• Describe the science behind chiropractic care
• Translate the intent of manipulative therapy to patients and other healthcare providers
• Describe the potential results of not having recommended chiropractic care
• Outline the different theories of the subluxation complex
• Justify the care you recommend based on electrodiagnostic, imaging, and laboratory studies

• Compare chiropractic maintenance care to symptom-guided care for patients with persistent or recurrent low back pain
• Investigate whether adding chiropractic care to usual medical care improves outcomes for military personnel suffering from low back pain
• Evaluate the research on the effectiveness of mobilization and manipulation for chronic non-specific low back pain
• Determine the effects of spinal manipulation on biochemical markers in humans
• Appraise the associations between chiropractic and primary care physician care in relation to acute lumbar disc herniation with early surgery

• This contains all courses with the educational objectives listed from Manipulation 117 through Manipulation 122

• Identify a sub-group of recurrent low back pain patients that might respond most favorably to a maintenance care schedule
• Summarize existing research literature on chiropractic maintenance care
• Investigate short-term changes in pain-pressure threshold (PPT) and temporal summation (TS) after lumbar spinal manipulation (SMT) compared to a credible sham intervention
• Determine whether cervical spinal manipulation leads to meaningful changes in vertebral and cerebral hemodynamics, compared to neutral or end-range neck rotation postures in adults with chronic neck pain
• Summarize the current state of the literature regarding the neurophysiological effects of high-velocity, low-amplitude spinal manipulative therapy (HVLA-SMT) in asymptomatic and symptomatic humans
• Critique the existing, sham-controlled literature evaluating the acute changes in autonomic nervous system (ANS) markers and function in patients receiving manipulation to spinal or peripheral joints

Hour 1

• Identify important spinal anatomy with relation to joint pain, degeneration and stabilization.
• Explain the efficacy of spinal manipulation (SM) for various clinical presentations
• Discuss current literature reviews regarding safety concerns and controversies with SM.
• Perform joint manipulative procedures to the spine and pelvis

 Hour 2

• Discuss common clinical anatomy related to the trunk and torso, with practically to joint manipulation.
• Examine the thoracic and lumbar spine through important clinical landmarks and topical anatomical structures.
• Perform alternative manipulative procedures to the spine and pelvis

 Hour 3

• Discuss common clinical anatomy related to the head, and neck.
• Examine the cervical spine through important clinical landmarks and topical anatomical structures.
• Perform joint manipulative procedures for cervical spine.
• Perform manipulative and mobilization procedures to the temporomandibular joints.

• Examine the effect of chiropractic manipulation on reaction and response time in combat-ready special operations forces qualified personnel
• Assess the influence of chiropractic care on the strength, balance, and/or endurance in active-duty United States military personnel
• Evaluate the impact of upper- vs lower-extremity chiropractic manipulation on postural sway and dual task performance
• Provide an update regarding the mechanisms of action for manual therapy, the impact of manual therapy on pain management, health care conditions for which manual therapy may be beneficial and treatment plans

Hour 1

• Review common foot and ankle anatomy.
• Evaluate the foot and ankle.
• Perform physical and neurological examinations and tests related to the foot and ankle.
• Identify uncomplicated common conditions during the evaluation of the foot and ankle.

 Hour 2

• Discuss evidence-based literature suggesting the practically of manipulation of the foot and ankle.
• Perform adjustments of the foot.
• Perform adjustments of the ankle.
• Utilize a speeder/toggle board for the foot.

 Hour 3

• Describe the impact of disturbances on the determinant factors of health in the structures of the foot and ankle
• Apply corrective and preventative measures to conditions affecting the health of the foot and ankle
• Utilize evidence-based low technology rehabilitative methods to manage patient care of common foot and ankle conditions.
• User strategies to address challenges patients have with adhering to rehabilitative programs.

Hour 1

• Review common hand, wrist and shoulder anatomy.
• Evaluate the hand write and shoulder.
• Perform physical and neurological examinations and tests related to hand wrist and shoulder.
• Identify uncomplicated common conditions during the evaluation of the hand wrist and shoulder

Hour 2

• Discuss evidence-based literature suggesting the practically of manipulation of the hand, wrist and shoulder.
• Perform adjustments of the hand.
• Perform adjustments of the wrist.
• Perform adjustments of the shoulder

Hour 3

• Describe the impact of disturbances on the determinant factors of health in the structures of the hand, wrist and shoulder
• Apply corrective and preventative measures to conditions affecting the health of the hand, wrist and shoulder
• Utilize evidence-based low technology rehabilitative methods to manage patient care of common hand, wrist and shoulder
• User strategies to address challenges patients have with adhering to rehabilitative programs.

• Summarize existing literature regarding the neurophysiological mechanisms of spinal manipulation for spine pain 
• Identify the beliefs, perceptions and practices of chiropractors and patients regarding benign adverse events after spinal manipulation and potential strategies to mitigate them
• Explore recent research pertaining to the importance or segmental pain and stiffness when targeting the application of spinal manipulation
• Assess the literature on the effect of SMT on acute neck pain, including pain, disability and quality of life measures and reported adverse effects
• Examine the evidence pertaining to the efficacy and effectiveness of spinal manipulation for preventing infectious disease and improving disease-specific health outcomes among patients with infectious disease

• Define and classify adverse events associated with manipulation and mobilization
• Review symptoms patients perceive as adverse
• Describe the incidence of severe adverse events among chiropractic recipients
• Outline adverse events in the pregnant and postpartum periods

• Describe the vertebral architectural distortion that predicts spinal imbalances. 
• Explain the factors involved in the etiology related to the primary components of the proprioceptor-cerebellar network. 
• Cite the law that establishes a classic chiropractic patient via radiograph. 
• Compare the classic manual osseous adjustment to Sensor-Based-Technique in regards to risk and effectiveness for reversing the cause of most chronic subluxations: An aberrant proprioceptor-cerebellar network feedback loop, (usually initiated by injury,) sustained through time by wedged vertebral bodies via Wolff's law, involving neuromuscular fixation engrams compensating for unlevel vertebral architecture. 
• Palpate the tendinous insertions of the paraspinal musculature in the areas of the spinous process tips and identify those areas that show tension, and demonstrate proper cross-friction massage at those points.

• Define Medical Error
• Discuss Medical Errors in the Context of Other Types of Error
• Illustrate the Scope of the Medical Error Problem
• List Serious Reportable Medical Events
• Define Key Events in the Field of Patient Safety
• Review the Epidemiology of Medical Error
• Describe the Taxonomy of Medical Error
• Identify commonly misdiagnosed conditions
• Identify populations of special vulnerability
• Review Types of Medical Errors
• Discuss Falls and Teamwork/Communication Errors and how to prevent them
• Summarize the following types of medical errors:
  1. medication errors
  2. handoff errors
  3. diagnostic errors
  4. healthcare acquired infections
  5. device associated infections
• List factors that increase the risk of the above medical errors
• Describe strategies to prevent the above medical errors

• Summarize the following types of medical errors:
  1. medication errors
  2. handoff errors
  3. diagnostic errors
  4. healthcare acquired infections
  5. device associated infections
• List factors that increase the risk of the above medical errors
• Describe strategies to prevent the above medical errors

• Recommend taking Medical Errors 202a and 202b prior to taking this course
• Summarize surgical errors and identify factors that increase the risk of surgical error as well as strategies to prevent them
• Discuss proper reporting of medical errors
• Enumerate the elements that comprise root cause analysis
• Describe strategies patients, providers, systems can use to reduce the risk of medical errors and improve patient health and safety
• Describe what to do when things go wrong

• Discuss the definition and scope of medical error
• Summarize the types of medical error
• Identify and describe ongoing safety research within the chiropractic profession
• Review the literature on the adverse events following chiropractic care
• Illustrate strategies to prevent common errors

Hour One:

• Discuss common medical errors made in the process of choosing diagnostic imaging for patients with cervical spine injuries
• Discuss the role of Clinical Prediction Rules and their role in preventing common errors in overutilization of radiographic studies in patients with cervical spine injuries
• Describe the Canadian C-Spine Rule, Canadian Head CT Rule and NEXUS Low-Risk Criteria, as well as their limitations and exceptions
• Review the literature supporting the use of Clinical Prediction Rules in the prevention of medical errors

Hour Two:

• Discuss limitations of plain film radiography in the evaluation of injured patients, and strategies to avoid medical errors due to inappropriate selection of imaging modalities
• Discuss relevant clinical indications for ordering advanced imaging studies in the evaluation of patients with cervical spine injuries
• Review common advanced imaging studies and their role in preventing medical errors of commission or omission
• Discuss the clinical relevance of recognizing loss of cervical motion segment integrity in the evaluation and management of injured patients

• List and define the components of the SINSS classification used for an upper quarter evaluation
• Recall two neurophysiological effects of upper quarter joint mobilizations
• Cite two indications for performing grade 1-2 joint mobilizations to the upper quarter
• Identify two conditions that would warrant performing grad 3-4 joint mobilizations to the upper quarter
• Enumerate 5 contraindications for performing joint mobilizations to the upper quarter State two specific diagnostic or impairment-based indications for performing a cervical distraction mobilization.
• Summarize the purpose for performing a posterior mobilization to the glenohumeral joint
• Paraphrase the clinical prediction rule used to determine the effectiveness of cervico-thoracic mobilizations for patient’s presenting with subacromial impingement.

• List and define the components of the SINSS classification used for a lower quarter evaluation
• Recall two neurophysiological effects of joint mobilizations as applied to the lower quarter
• Cite two indications for performing grade 1-2 joint mobilizations for the lower quarter
• Identify two conditions that would warrant performing grad 3-4 joint mobilizations for the lower quarter
• Enumerate 5 contraindications for performing joint mobilizations as applied to the lower quarter
• State two specific diagnostic or impairment-based indications for performing a lateral to caudal hip joint mobilization.
• Explain the purpose for performing a posterior to anterior proximal tibiofibular glide
• Provide two common indications for performing a medial patella mobilization technique

• Discuss the history behind the discovery of and development of releasing somatic dysfunction via positional release techniques via the work of Lawrence Jones, DO, George Goodheart, DC and others
• Discuss the basic concepts of how the body responds to stress and trauma  according to Irvin Korr and how slackening the dysfunctional muscle and joint tissues works to restore normal function.
• Apply anatomy and kinesiology as a means of finding and unwinding somatic dysfunction.
• Include the learned techniques into your practice.
• Compare and contrast the rapid thrust vs. positional release modes of releasing subluxations or somatic dysfunction. 

• Summarize the muscle spindle, specifically, the anatomy and physiology of the spindle subcomponents and how it regulates function of skeletal muscle.
• Breakdown the neural reflex mechanisms of the muscle spindle and appreciate how these mechanisms operate in both somatic function and dysfunction.
• Explain the hypothesis of the “facilitated segment” aka somatic dysfunction, explained both in terms of neurology and by analogies so as to be clear to both the doctor and the patient
• Identify somatic dysfunction via locating tender points and learn the mechanism of slackening in order to relieve the tender point reactivity and restore normal function to the muscle and joint.
• Identify and correct tender point locations and positional releases.

• Define the basic principles of MRI imaging as it relates to the musculoskeletal system.
• Summarize current criteria utilized to identify Lumbar pathology and the appropriate lexicon utilized in neuroradiology to assist the Doctor of Chiropractic in interpreting studies ordered.
• Identify normal anatomy of the lumbar spine on MRI images.
• Differentiate gross pathology associated with the most common MRI presentations associated with general Chiropractic practice.
• Assess the necessity of MRI imaging for lumbar pathology, with an understanding of the pathophysiology of the degenerative process associated with lumbar spine aging

Hour 1:

• Describe the tensegrity model as it relates to biomechanics from a cellular to organism level.
• Define fascia, including anatomical lines and physical properties.
• Describe the Dural Fascial Kinetic Chain and its relationship to Adverse Mechanical Tension (AMT) on the spine and CNS.
• Describe the clinical relevance of biotensegrity, and how to apply these updated architectural and biomechanical principles to the delivery of chiropractic adjustments.

Hour 2:

• Explain the impact of chronic stress
• Recognize common signs and symptoms of sympatheticotonia during initial patient presentation.
• Outline the diagnostic process for sympatheticotonia, including both testing and interpretation.
• Summarize clinical considerations for the patient with sympatheticotonia.

Hour 3:

• Recognize and describe the common signs and symptoms of imbalance during initial patient presentation.
• Outline and demonstrate testing procedures for imbalance.
• Describe clinical interpretation of test results for imbalance.
• Make referral for imbalance when appropriate.

Hour 4:

• Describe statistical incidence and association with head and neck trauma
• Be able to recognize in clinical practice the common signs and symptoms of head and neck trauma
• Outline the diagnostic process for head and neck trauma, including both testing and interpretation.
• Summarize clinical considerations for the patient with head and neck trauma

• This contains all courses with the educational objectives listed for NeuroFascial Integration 201 - 203

Hour 1:

• Describe layered components of restrictions including updated osseous, muscular, and fascial relational anatomy.
• Describe how to palpate muscle tension versus fascial adhesion versus fascial tension lines.
• Differentiate between osseous restriction, muscular tension, and fascial restriction as they relate to spinal motion restriction.
• Use palpatory findings to select technique application for adjustments that last longer by addressing mechanical root cause and encourage parasympathetic dominance at rest.

Hour 2:

• Describe the difference between static misalignments and dynamic spinal restrictions (joints incapable of full range of motion).
• Differentiate with palpation both static and dynamic spinal restrictions.
• Describe neurological information gathered from palpation, including dysesthesia, hyperesthesia, reactive erythema, temperature differentials, and other signs.
• Palpate the patient with chronic pain, trauma history, and/or sympatheticotonia without triggering sympathetic bracing.

Hour 3:

• Describe the Oxford Grading Scale for manual muscle testing.
• Describe interpretation of manual muscle testing findings, including differentials for clinical significance of findings other than normal.
• Demonstrate manual muscle testing of major postural muscles.
• Apply manual muscle testing as pre- and post-clinical intervention measures during adjustment visits and to track change during review examination.

Hour 4:

• Describe the relevance of clinical history as it relates to chronic stress and trauma.
• List specific questions to assess for sympatheticotonia.
• List specific questions to assess for indications of head and neck trauma
• Determine appropriate individualized examination procedures based on history answers.

Hour 1:

• List the relevant indications to assess using cross-crawl patterning.
• Describe testing procedures to determine specific cross-crawl pattern issues
• Describe testing procedures to assess for signs of sympatheticotonia.
• Describe testing procedures to assess for signs of imbalance.

Hour 2:

• Perform seated functional range of motion testing with segmental and curve analysis.
• Perform standing functional range of motion testing with segmental and curve analysis.
• Describe fascial considerations to modify common orthopedic tests (including straight leg raise, supine apparent arm length inequality, bilateral prone knee flexion, and soto hall).
• List the orthopedic exam procedures specifically relevant to Fascial Kinetic Chain tension.

Hour 3:

• Describe clinical considerations in terms of safety of providing care (knowing when to adjust and when NOT to adjust).
• Define what is “primary” (including considerations of “cause” as well as “least stressful point of access” to determine what to adjust or otherwise apply therapeutic input).
• Recognize patterns of and describe gestalt clinical interpretation for sympatheticotonia.
• Recognize patterns of and describe gestalt clinical interpretation for adverse mechanical tension in the Fascial Kinetic Chain
• Describe patterns of peripheral nerve interference found through synthesis of clinical history and exam procedures.

Hour 4:

• Summarize the concept of an initial Therapeutic Trial of care, including reasoning behind it and how to complete this extension of initial assessment in order to customize patient care.
• Describe considerations for technique selection (including where to start, how intensely to adjust, and how to adjust).
• Explain reasoning behind initial frequency of care, and how/when/why to modify this frequency.
• Describe the considerations for projecting response to care and prognosis.
• Summarize guidelines for patient home care recommendations, including considerations for movement and rest, ergonomics, nutrition, and referrals when appropriate.

• Demonstrate skills to properly perform a patient interview
• Properly record a chief complaint
• Perform a neurological examination of the head and neck
• Perform a mental status examination

• This course contains all content from Neurological Exam 101 through 107. Please see educational objectives for those courses

• Cite anatomy and function of the cranial nerves
• Examine the twelve cranial nerves during a clinical examination
• Discuss disorders of cranial nerves

• Perform and chart a neurological examination of the voluntary motor system and the somatic sensory system
• Apply results of the examination findings in the differential diagnosis of patients
• Describe the three neuron pathway involved with sensorineural innervation
• Discuss multimodal sensations

• Perform an appropriate examination of the reflexes, including deep tendon, superficial, visceral and pathological reflexes
• Describe the anatomy associated with reflexes
• Properly grade and record reflexes
• Interpret the Results of Reflex Testing