Greece Chiropractic Continuing Education

Hour 1:

• Comprehend the human frame as interrelated biomechanical systems.
• Relate the functional anatomy of soft tissue structures to the movement of the human frame.
• Discern the six types of soft tissue end feel for evaluation of injury.
• Perform passive and active examination according to protocol developed by James Cyriax, MD.
• Distinguish between the types of injury and their effects on the soft tissues.

Hour 2:

• Identify soft tissue changes associated with injury.
• Discern which phase of healing is associated with the current presentation of injury.
• Apply mechanisms of healing to treatment protocol.
• Discuss diagnostic tools used to identify soft tissue injury.
• Utilize appropriate ice, heat and stretch protocols in the treatment of soft tissue injury.

Hour 3:

• Explain and perform Somatic Technique and Strain/Counterstrain.
• Understand friction anesthesia and palpatory methods for identifying trigger points.
• Differentiate between Postisometric Relaxation and Postfacilitation Stretch.
• Apply specific modalities for particular soft tissue injury patterns.
• Perform soft tissue restriction release methods.

Hour 4:

• Discern between mobilization and manipulation.
• Apply biomechanics of foot arch function to injury.
• Explain dynamic changes of foot during weight bearing, and walking on even and uneven surfaces.
• Utilize treatment protocols for common ankle sprains.
• Perform osseous manipulation to the bones of the foot and ankle.

Hour 5:

• Perform Strain/Counterstrain on the foot and ankle as an effective tool to release spasm and fixations.
• Discern and treat various pathological conditions related to the knee.
• Utilize myofascial release techniques to treat entrapment syndromes of the lower extremity.
• Explain functional movement of the hip.
• Apply functional kinesiology to the evaluation and treatment of the muscles associated with the hip.

Hour 6:

• Utilize treatment methods for contracted soft tissues of the lateral hip.
• Perform treatment protocols for the hamstrings/quadratus femoris.
• Explain the dynamics of correct posture.
• Recognize normal versus abnormal gait in patient observation.
• Describe nutation and counternutation of the pelvis.

Hour 7:

• Understand the various movements and fixations patterns in the Sacroiliac joints.
• Perform Strain/Counterstrain for the pelvis.
• Utilize a disc pump correction for mild to moderate disc lesions.
• Demonstrate James Cyriax MD protocol from manipulation of the low back.
• Devise a treatment protocol for sprain of the iliolumbar ligament.

Hour 8:

• Apply movement dynamics of the lumbopelvic spine to soft tissue injury.
• Utilize chest movement dynamics to help determine injury to the thoracic spine and rib cage.
• Provide affective treatment of the rib cage specific to rib articulations.
• Perform somatic Technique to the trapezius muscle for muscle awareness.
• Apply treatments to soft tissues of the rib cage without using electric modalities.

Hour 9:

• Discuss cervical spine mechanics as it applies to soft tissue injury.
• Create muscle awareness of the cervical extensor group with Somatic Technique.
• Reduce pain and spasm in an acute cervical spine injury using Strain/Counterstrain.
• Apply myofascial release to the soft tissues of the posterior cervico-thoracic spine.
• Educate the patient on corrective scoliosis exercises.

Hour 10:

• Relate the functional anatomy of the TMJ to soft tissue injury.
• Discern between Acute Closed lock and Acute Open Lock of the TMJ.
• Apply soft tissue treatments to the muscles of the TMJ.
• Use movement dynamics of the shoulder to better evaluate injury.
• Utilize a variety of soft tissue treatment in the treatment of adhesive capsulitis of the shoulder.

Hour 11:

• Differentially diagnose acromioclavicular joint injury and apply treatment to grades 1-3.
• Use soft tissue methods to treat the muscles of the rotator cuff.
• Discern and treat soft tissue structures related to the scapula.
• Perform a scapula mobilization technique to free up the functional scapulo-thoracic joint.
• Apply mechanisms of throwing to soft tissue injury and treatment.

Hour 12:

• Describe various soft tissue treatments for the elbow, wrist and hand and related functional dynamics of injury.
• Osseously manipulate the joints of the elbow, wrist and hand.
• Perform soft tissue treatment methods for injury to the myofascia associated with the upper extremity.
• Discern and treat all injured tendon sheath components of the wrist using soft tissue treatment methods.
• Differentially diagnose and treat nerve entrapment syndromes for the upper extremity.

• Explain the structural components of soft tissue.
• Relate impact forces to functional movements of soft tissue and the development of scar tissue and adhesions.
• Demonstrate diagnostic evaluation of soft tissue injury.
• Differentially diagnose types of soft tissue injury.
• Discuss the patterns of healing of soft tissue injuries.
• Describe the diagnostic tools in determining soft tissue injuries.
• Relate stress responses of soft tissues to development of structural and functional changes to injured tissues and their associated regions.
• Perform diagnostic tests and order imaging to best determine injury to soft tissue.
• Instruct the patient on correct application of ice and wet heat for soft tissue injury.
• Perform and explain proper stretching; passive, active and postfacilitation of soft tissues.
• Learn which therapy machines are best suited for your practice.
• Utilize infrared and electrical muscle stimulation in soft tissue injury.
• Apply appropriate contraindications of electric modalities to the individual patient’s care.
• Discern between the various EMS options for each soft tissue and injury (Interferentail current, galvanic, microcurrent, sine wave, Russian stimulation).
• Determine the most effective type of ultrasound for treatment of particular soft tissue injuries.
• Learn the benefits and applications of cold laser therapy.
• Understand the variety of massage therapy protocols and their applications.
• Discuss the benefits of each form of modality with your patient.
• Demonstrate and discuss exercise rehabilitation and muscle strengthening.
• Apply a combination of modalities for specific conditions of the upper and lower extremities and the spine.

• Discuss the normal function of soft tissues for support and movement to relate soft tissue injuries to postural anomalies. 
• Utilize the evaluation of the feet as a foundation for full body postural adaptations.
• Relate normal biomechanics of the foot, ankle, knee, hip, pelvis, spine, TMJ and upper extremities to normal posture and movement.
• Apply findings of injured soft tissues of the foot, ankle, knee, hip, pelvis, spine, TMJ and upper extremities to evaluation of normal and abnormal postural distortions.
• Discuss dynamic muscle stabilizers in the pelvis and abdominal core in relation to normal movement and fixations in the hip and pelvis.
• Relate the thoracic spine and rib cage to dynamic movement and postural adaptations in the spine, upper and lower extremities.
• Evaluate cervical joint dynamics in relation to compensations from the thoracic spine and rib cage, upper extremity and TMJ.
• Discern impact of TMJ function on cervical spine posture and head tilt.
• Relate abnormal scapular, glenohumeral joint and rotator cuff function to specific spinal and upper extremity postural distortions.
• Educate the patient in normal standing, seated, computer ergonomic, reclined, recumbent positions and normal gait to discern and recognize postural abnormalities.
• Relate functional dynamics during Acceleration/Deceleration Impact to soft tissue injury and postural adaptations to those injuries.
• Define causative factors for Scoliosis and relate muscle disparities of the multifidus to spinal, pelvic, rib cage and shoulder postural distortions for treatment protocol.
• Educate on causes of shoulder rounding, shoulder elevation; and backpack, throwing, tennis, golf, swimming, overhead sports injuries and their effects on spinal posture for rehabilitation.
• Understand and apply soft tissue treatment methods for the three posture types of Somatic Technique Theory: Red Light, Green Light and Dark Vise.
• Use Strain/Counterstrain, Friction Massage and Postisometric Relaxation as an effective tool for soft tissue damage contributing to postural distortion.
• Apply soft tissue treatment methods, modalities and rehabilitation to Pelvic Crossed Syndrome and Shoulder Crossed Syndrome.
• Apply Yoga for full body and regional postural corrections.
• Understand and explain proper postures for dance, martial arts, running, cycling, baseball, golf, tennis, standing, walking, sitting, computer ergonomics and sleeping.

• Identify the goals, indications and contraindications of spinal traction and decompression
• Predict responsive patient selection for spinal traction and decompression
• Plot phases of traction and calculate the appropriate force, traction and hold times
• Evaluate the validity of logarithmic pulls and disc targeting
• Define ethical behavior for billing and marketing of non-surgical spinal decompression device

• Develop and overview of Adult Golf Injury Assessment and Rehab
• Identify the nature of balance and applying balance assessment to golfers
• Review and Understand the concepts of coordination as applied to golf

• Identify which trunk muscles are used in the golf swing
• Review the Chiropractic influence on the golf swing
• Construct practical swing suggestions for golf patients
• Discuss fundamental conditioning concepts
• Prepare physical conditioning to improve club speed

• Differentiate the basic fundamentals of the golf swing and ball flight
• Understand the epidemiology of golf injuries in both professionals and amateurs
• Discuss the factors that influence injury formation and prevention
• Learn the shoulder muscles involved in the various phases of the golf swing and apply this knowledge to examination and rehabilitation
• Learn about the relationship between back pain and elite golf mechanics
• Determine the spinal and metabolic loading characteristics associated with golf

• Illustrate basic principles of cardiorespiratory exercise
• Outline health screening and physical fitness testing
• Create cardiorespiratory and strength training exercise prescriptions

• Describe the biomechanical fundamentals of grip, posture and swing
• Identify golf injuries and golfers’ problems
• Develop protocols of rehab, strength training and adjusting for golfers

• Investigate the anatomical structures strained during the Ober and Modified Ober tests for iliotibial band concerns
• Evaluate the utility of screening tests for predicting injury risk in athletes
• Describe the biomechanics associated with the extensor carpi ulnaris and recognize the variety of pathologies that can affect this structure
• Summarize recommendations for the assessment, diagnosis and management of Femoroacetabular Impingement (FAI)
• Assess whether expert and novice Functional Movement Screen raters can report the same scores

• Illustrate the pathogenesis of CADs ­dissection mechanisms
• Identify putative causes and triggers of CAD
• Estimate the purported incidence of cerebrovascular syndromes following cervical manipulation
• Distinguish between the neurological syndromes
• Identify stroke risk factors in general
• Assess the value of pre-manipulation testing: to screen or not to screen?
• Outline the warning signs/symptoms of CAD
• Indicate what to include in the patient history and examination
• Describe what to do if you suspect CAD
• Point out how to communicate risk to patients as well as implementing strategies to prevent CAD
• Assess the current literature on the relationship between stroke and manipulation
• Describe the anatomy of the blood supply to the brain
• Summarize the clinical biomechanics of vertebral arteries
• Outline the epidemiology and classification of cervicocerebral (vertebral and internal carotid) arterial dissections (CAD) or strokes
• Recognize the diseases affecting cervicocerebral arteries

• Compare the associations of chiropractic care and stroke with primary care physician (PCP) care and stroke in the Medicare population
• Quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66 to 99 years with neck pain
• Determine the hemodynamics in the Circle of Willis with Internal Carotid Artery Stenosis under cervical rotatory manipulation: a finite element analysis
• Review compensation claims for chiropractic in Denmark and Norway 2004-2012
• Examine the risk of traumatic injury associated with chiropractic SMT in the Medicare population

• Compare the risk of injury (via Medicare data) between two cohorts of patients treated by chiropractic spinal manipulation versus treatment by a primary care physician
• Investigate the association between chiropractic manipulative treatment and vertebrobasilar artery stroke
• Assess the level and quality of evidence regarding the potential association between cervical manipulation and cervical artery dissection/stroke
• Evaluate the diagnostic accuracy of premanipulative vertebrobasilar tests in terms of sensitivity, specificity, predictive values and likelihood ratios in adults
• Observe vertebral artery blood-flow after cervical manipulation and various head positions

• Outline methods used and estimations as to the incidence of cervical spinal manipulative therapy and subsequent vertebrobasilar ischemia.
• Review and describe cerebrovascular anatomy and hemodynamics.
• Discuss proposed patho-physiological mechanisms believed responsible for subsequent vertebrobasilar ischemia.
• Review and discuss past and present scientific literature to explore the evolution of what we think we know about the process of cervical spinal manipulative therapy and subsequent vertebrobasilar ischemia.
• Identify radiographic signs of a vertebral artery dissection.
• List and discuss the uses, pros and cons of current examination tools as they apply to vertebral artery dissection.
• Explore issues and examination procedures related to patient assessment as well as vertebrobasilar ischemia recognition and proper diagnosis.
• Define and contrast currently suggested procedures and develop a vertebrobasilar ischemia plan of action.
• Explore various perspectives and reveal bias in both public media and biomedical journals.
• Identify and define new theoretical concepts and prophylactic therapies.
• Give multiple examples of anti-chiropractic bias in the biomedical literature
• List and describe the most common red flags for a patient “at risk” for suffering Vertebrobasilar Ischemia following cervical manipulation.
• Recite list of scientific studies relating to laboratory testing of plasma Homocystine levels and its relationship to Vertebrobasilar Ischemia from vertebral artery dissection.
• List examples of bias against chiropractic cited in both the popular media as well as in biomedical journals.
• Critically review landmark articles regarding the issue of cervical manipulation and vertebrobasilar distribution ischemia.
• List studies suggesting that a high plasma homocystine level may be associated with vertebrobasilar dissection.
• Cite studies suggesting that increasing folic acid intake can reduce plasma Homocystine levels.
• Identify laboratory tests that may be useful in helping calculate an individual’s risk of suffering vertebrobasilar stroke following cervical manipulation.

• Cite the strength of evidence about whether chiropractic neck manipulation causes cervical artery dissection (CAD) based on a systematic review, meta-analysis, and evaluation of the body of evidence as a whole
• Summarize our current state of knowledge on cervical artery dissection and how it impacts the practice of cervical spinal manipulation
• Outline the state of knowledge regarding bedside diagnosis and management of an acute vestibular syndrome, with the suspicion for stroke 
• Describe the demographics, past health care utilization, and comorbidities of vertebrobasilar artery stroke patients in Ontario, Canada who consulted a chiropractor within one year prior to their stroke
• Analyze the nature of internal carotid artery biomechanics and associated risk of injury during cervical spinal manipulation

• Determine the epidemiology, etiology and background on obesity
• Assess the theories of obesity development and pathophysiology
• Outline the risks and morbidities related to obesity

• Outline the management of obesity
• Summarize the assessment of obesity for the busy clinician
• Synthesize the literature on the dietary management of obesity
• Discuss the role of exercise and physical fitness in the management of obesity and overweight

• Outline the principles of body composition assessment
• Review the anthropometic measures of body composition
• Discuss the circumference measurements of body composition
• Assess the laboratory and field assessments of body composition

• Outline the definition and components of health and wellness
• Review the dimensions of wellness
• Discuss various models of health and the need for wellness lifestyles
• Outline the publication and goals of Healthy People

• Discuss a common origin of lumbar disc pain
• Describe the orientation of lumbar facet joints
• Identify the effect of lordosis on the position of the nucleus pulposis
• Establish how injuries of the annulus fibrosus can cause nerve root changes
• Identify the dynamic stenosis of the lumbar spine

• Identify anatomical structures of the knee involved with anterior knee pain
• Diagnose fat pad and bursitis syndromes
• Establish pathologies of the patellar tendon in adults and children
• Differentiate different causes of patellofemoral pain
• Match clinical syndromes of knee pain with radiological appearances

• Identify the general anatomy of the knee joint
• Develop an intimate knowledge of the anatomy of the menisci and ligaments of the knee using gross dissection and cross-sectional imaging
• Understand the functional anatomy of the menisci of the knee and define the type and grade of meniscal tears
• Establish the conditions discoid lateral meniscus and meniscal cyst and understand the spectrum of treatment available
• Identify what type treatment is available for meniscal injuries and when it would be prudent to reevaluate a post-op patient with new knee pain

• Outline the physical basis of magnetic resonance imaging
• Identify patients that are candidates for an MRI
• Recognize categories of pathology in the spine that are imaged well with MRI
• Recognize cases that require contrast
• List contraindications for an MRI

• Identify and classify injuries to the anterior cruciate ligament
• Diagnose and develop treatment for injuries to the posterior cruciate ligament
• Diagnose and develop treatment for injuries to the medial collateral ligament
• Diagnose and develop treatment for injuries to the lateral collateral ligament
• Describe and classify ostochondritis dissecans of the knee

• Differentiate ossification from calcification
• Identify the categories of ossification
• Differentiate myositis ossificans progressiva from myositis ossificans traumatica
• Discuss imaging utilization with regards to ossification
• Review common and uncommon entities predisposed to ossification or calcification

• Recognize and identify important key factors for interpreting plain film x-rays of the spine and pelvis
• Recognize important medical/legal issues regarding interpreting plain films of the spine and pelvis and be able to apply appropriate radiographic documentation requirements when charting x-ray findings in the medical record
• Identify, analyze and interpret normal and abnormal anatomical osseous structures, common congenital and acquired pathologies, common normal radiographic variants and soft tissue calcifications/structures of the cervical, thoracic, lumbar, lumbosacral spine and pelvis

• Alert your clinical consciousness to prevent complacency
• Explain ways to identify the most common aneurysms clinically and on x-ray in the abdominal aorta, thoracic aorta, and splenic artery
• Differentiate aneurysm from dissection and pseudoaneurysm

• Identify the source of metastatic lesions
• Determine an advanced imaging protocol once a metastatic lesion is found
• Discuss how to identify on radiographs the two most common primary malignancies of bone - multiple myeloma and osteosarcoma

• Discuss the fundamental role of trauma in musculoskeletal disease and the various diagnostic imaging techniques used to evaluate it
• Identify, describe, and classify fractures by both direct & indirect radiographic signs
• Review fractures of specific etiologies based upon imaging findings
• Evaluate fracture alignment issues, complications, and healing
• Identify non-accidental injury of childhood, as well as normal structures that mimic fractures

• Understand Osteoporosis - (risk factors, incidence, prevalence, morbidity, etc.)
• Understand the fundamentals of DEXA (dual-energy x-ray absorptiometry), the gold standard in bone density testing
• Explain how to interpret the results
• Investigate the advantages and limitations of DEXA
• Investigate the indications and contraindications for utilization of DEXA