California Chiropractic Continuing Education

Hour 1

• Identify some common gait abnormalities seen in gait analysis and develop mental strategies in evaluating the 3 cardinal planes of motion and potential failures in the loading of these planes.
• Categorize the Fast and Slow phases of an imbalance asymmetrical gait and define rehabilitation strategies to remedy the gait pathology.
• Develop a conceptual overview of how step length and stride length change in a limping gait.
• Breakdown portions of the gait cycle into its component parts, including compensation patterns
• Conceptualize the gait changes oriented around a hallux (great toe) amputation and learn to predict gait compensations off of a fixed anatomic anomaly.
• Describe arm swing and how it plays out in gait, particularly asymmetrical, and develop some treatment concepts in addressing this asymmetry.

Hour 2

• Discuss the critical function of the deep neck flexors and transverse abdominus, and how they related to gait, especially the running athlete.
• Identify the 3 compartments of the thoracolumbar fascia and translate them into gait concepts and treatment concepts.
• Develop treatment concepts in addressing this asymmetry and define in-phase and out-of-phase arm and leg swing assimilation
• Discuss on a surface level the concepts of speed in gait, and how to adjust the speed of one's gait to break down gait components that might lead to better treatment directions.
• Describe central pattern generators and relate to arm swing on a neurologic level.
• Recognize some common gait abnormalities seen in gait analysis such as arm swing, step length, the cross over gait, and develop mental strategies in evaluating the 3 cardinal planes of motion and potential failures in the loading of these planes when it comes to these gait parameters.

• Present the etiology of blister and callus formation
• Review the gait cycle and the biomechanical events relevant to callus formation
• Review pronation and supination motions of the foot and how they relate to low and high gear push off
• Review the 3 rockers and how they can relate to callus formation
• Discuss the more common callus patterns in feet
• Describe the foot pathomechanics that lead to callus formation

• Describe the biomechanics of rotation of a thoracic ring at the levels T1-T7.
• Describe the biomechanics of the Cervical spine, Thoracic spine, ribs, clavicle and manubrium with elevation of the right or left shoulder.
• Describe the biomechanics of flexion and extension at the Costotransverse joint at T9.
• Describe the differences in motion of the mobile segments between T3 -T7 with side flexion occurring first in the Thoracic spine.

• Describe the physiology of breathing and how altered pH can affect the body.
• Describe two functions of the diaphragm.
• Identify limited chest expansion and Bradcliff angles and ski jumps
• Identify limited lateral costal breathing and how to facilitate normal lateral costal breathing

• Describe how altered breathing patterns can alter pH and how this can affect the body.
• Describe the autonomic nervous system and function.
• Name three physiological consequences of respiratory alkalosis.
• Describe suboptimal breathing patterns and their effect on the cervical spine and chronic pain.

• Name and describe the different types of sleep apnea.
• Describe the three levels of Apnea-hypopnea index AHI.
• List five symptoms of sleep apnea.
• List two treatments for sleep apnea.

• Summarize the three stages of pregnancy.
• Recognize common pregnancy abbreviations.
• List the benefits of exercise during pregnancy.
• Explain how the hormones, relaxin and hCG, can impact physical activity.
• Design a subjective and history taking examination for a pregnant patient.
• Complete a physical examination on a pregnant patient including common complaints such as pelvic girdle pain and low back pain.
• Assess patient positions to ensure comfort and safety during physical assessments and/or rehabilitation.
• Recognize when to refer a pregnant patient to another specialty for evaluation and treatment.
• Identify pelvic health dysfunction and determine appropriate referral.

• Evaluation of post-partum patients
• Common complaints and assessment – LBP/SI, pelvic floor dysfunction, DRA
• Impact of birth type/healing time frame
• Biomechanics of lifting and carrying baby
• Sleep, activity, and nutritional considerations

• Discuss the theories of why aging is now seen as a disease, characterized by chronic inflammation, which could potentially be stopped or even reversed. 
• Share how persistent, low-level inflammation (inflammaging) contributes to the deterioration of cellular and systemic functions, driving the aging process and the development of age-related chronic diseases.
• Examine the role of mitochondrial dysfunction in aging, exploring how improving mitochondrial health can promote longevity and reduce age-related decline.
• Identify clinical strategies to integrate mitochondrial health and anti-inflammatory practices into patient care to enhance healthy aging and mitigate the impact of chronic diseases.
• Introduction to low-level laser therapy, its core principles, and its mechanism of action for healing and optimizing cellular function.
• Explain the role of the mitochondria in cellular energy production and overall health.
• Review evidence-based applications of low-level laser therapy in promoting mitochondrial health via evidence-based research findings and data.
• Discuss practical approaches for integrating low-level laser therapy into clinical practice to enhance patient outcomes in managing mitochondrial dysfunction and promoting cellular rejuvenation.
• Share the global impact of metabolic dysfunction and discuss the effects of obesity driving chronic inflammation and its link to chronic health conditions.
• Discuss the mechanisms through which excess body fat and underlying metabolic dysfunction contributes to inflammatory processes and hormonal/endocrine dysfunction.
• Elaborate on clinical insights into effective interventions for combating obesity, improving metabolic health, and reducing inflammation, including dietary changes, physical activity, and sleep.
• Explore emerging therapies and technologies aimed at improving metabolic function and reducing inflammation, focusing on their potential applications in clinical practice.
• Discuss mechanisms of aging and how the aging process is being challenged by both conventional and alternative medical communities. 
• Provide a comprehensive analysis of nutritional, dietary, and lifestyle-based interventions that have shown promising outcomes for improving longevity and quality of life outcomes. 
• Overview of major concepts, themes, and discussions about the importance of diet, nutrition, and controlling blood sugar to optimize metabolic capacity to maximize aging. 
• Examine emerging research on cellular regeneration and mitochondrial function as critical components in slowing the aging process and enhancing longevity.

Hour 1

• Define Ethics
• Review various ethical issues recently reported on
• Identify ethics as related to the whistleblower
• Discuss Ethical standards specific to laws in various states

Hour 2

• Discuss Ethical standards specific to laws in various states (cont’d)
• Summarize awareness related to anti-discrimination
• Classify various aspects of professional boundaries and sexual misconduct

• Simplify the progressive cause-effect relationship of disease from biochemical imbalances to physiological disturbances to cellular/organ degeneration to disease manifestation
• Identify the five primary underlying etiologies of virtually all chronic degenerative disease
• Analyze the most common antecedents and triggers that predispose your patients to disease
• Devise an evaluation algorithm that efficiently guides your testing recommendations
• Discover novel in-office testing procedures that cost-effectively demonstrate patients’ nutrient insufficiencies; unmanaged stress; toxic burden; and sleep “debt”
• Evaluate Heart Rate Variability test results to easily measure and demonstrate patients’ stress adaptability as well as their response to treatment modalities
• Discriminate the meaningful information gleaned from Bio-Impedance Analysis (BIA) testing for monitoring your patients’ health restoration progress
• Interpret evaluation results to efficiently identify which primary factors are contributing to your patients’ health challenges
• Prioritize treatment plans that address both short-term goals (symptomatic relief) and long-term goals (correction, stabilization and prevention)
• Distinguish which nutraceuticals best support patient needs based on history, exam, testing and symptomatology
• Communicate the functional medicine model of health and disease with your patients with greater clarity and ease

• Discuss ethical standards of insurance reporting and coding
• Illustrate how documentation can affect state board complaints
• Discuss why insurance companies file complaints against chiropractors
• Discuss why patients file board complaints against chiropractors
• Define the Problem Oriented Medical Record (POMR)
• Illustrate taking a thorough history using the OPQRST method
• Discuss the components of the ortho/neuro exam

Hour 1

• Discuss an overview of Cerebellar Tonsillar Ectopia
• Discuss the statistical incidence and association with head and neck trauma
• Identify associated and confounding Factors
• Recognize in clinical practice the common signs and symptoms of CTE
• Refer for appropriate evaluation and diagnostic imaging for patients with this condition

 Hour 2

• Appraise Updated Biomechanics: The Biotensegrity Model
• 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
• Describe the clinical relevance of biotensegrity, and how to apply these updated architectural and biomechanical principles to the delivery of chiropractic adjustments.
• Identify the different types of Adverse Mechanical Tension affecting patients
• Discuss the relationship between fascia and CNS function, including both direct mechanical tension and embedded proprioceptive/nociceptive feedback mechanisms influencing autonomic neurological function.

 Hour 3

• Explain CNS distortion: Chronic Stress
• Summarize the impact of chronic stress on CNS processing.
• List Common types of dysautonomia
• Recognize common signs and symptoms of dysautonomia during initial patient presentation.
• Explain the diagnostic process for dysautonomia, including both testing and interpretation.
• Summarize clinical considerations for the patient with sympatheticotonia.

 Hour 4

• Recognize CSF hydrodynamics and cranial anatomy, and related symptomatology.
• Recognize and describe the common signs and symptoms of abnormal hydrodynamics and Adverse Mechanical Tension (AMT) affecting cranial and dural dynamics.
• Refer for appropriate evaluation and testing procedures for CSF and cranial dynamics.
• Perform modified cranial and fascial release techniques

• Explain the origin of the vagus nerve, its anatomy, and its critical role in regulating bodily functions, including its connection to the sympathetic and parasympathetic nervous systems.
• Describe common causes of headaches and explore how the vagus nerve contributes to the pathophysiology of headache conditions.
• Discuss the science behind vagus nerve stimulation, its impact on neurological pathways, and its therapeutic benefits for treating headaches, epilepsy, treatment-resistant depression, reduced anxiety, and improved mood.
• Assess the efficacy and limitations of vagus nerve stimulation as a non-invasive treatment for headache reduction, referencing current research and clinical findings.
• Review the range of vagus nerve stimulation devices, from surgically implanted medical devices to over-the-counter options, and discuss their appropriate uses and considerations.

History and Background

• Recognize the historical emergence of spinal manipulation (SMT) throughout numerous time periods and among different professions
• Outline the development of the chiropractic profession from the late 1800s to modern day
• Briefly review existing and historical models of spinal manipulative therapy (SMT)

What’s that sound?

• Distinguish cavitation from tribonucleation and explore the relevance of the popping sound with SMT.

 Mechanisms

• Integrate the concept of mechanotransduction into your understanding and appraisal of SMT mechanisms
• Outline different ways methods to provide mechanical stimulation during chiropractic treatment
• Explain what the evidence tells us about joint motion, gapping and location of popping sounds with SMT
• Explore contemporary areas of scientific inquiry into the neurophysiologic mechanism(s) of action for high-velocity spinal manipulation
• Describe how SMT may influence pain modulation
• Critique the evidence relating to the influence of SMT on blood biomarkers and immunity
• Discuss the potential brain and sensorimotor functional impacts of SMT
• Appreciate the relevance of spinal stiffness and the potential impact of SMT on spinal biomechanics
• Summarize existing evidence relating to the SMT and muscle function.

Clinical Considerations

• Describe clinical factors that could influence how SMT exerts its effect(s).
• Discuss existing evidence on the dose-response relationship between SMT and clinical outcomes.
• Recognize the importance of contextual factors, patient expectations and comfort in driving positive clinical outcomes.
• Briefly summarize existing research on studies evaluating SMT for non-spinal conditions.

Course Conclusion

• Propose an integrated, conceptual model of how SMT may exert its effects for our patients.
• Recognize that chiropractic care helps patients via many aspects of the clinical encounter.

• Differentiate various nutrition assessment techniques.
• Determine which body fat/composition technique is most appropriate for the individual.
• Calculate essential measurements for weight loss patients.

• Design an effective nutrition treatment program for carpal tunnel syndrome
• Develop a nutritional treatment program for Multiple Sclerosis
• Investigate the role of nutrition and supplements in regards to the treatment of headaches
• Understand how nutrition and nutrition supplements can influence dementia
• Identify appropriate diet and supplement agents in the treatment of dementia

• Explain the basic principles of nutrigenomics, focusing on the interaction between nutrition, genetics, and health outcomes, with an emphasis on conditions like headaches.
• Analyze how single nucleotide polymorphisms (SNPs) and other genetic variations impact nutrient metabolism and their potential role in triggering headaches, such as those linked to impaired methylation.
• Examine the mechanisms by which a lack of essential nutrients (e.g., magnesium, B vitamins) contributes to headaches, and how nutrigenomics can inform targeted nutritional interventions.
• Design tailored dietary strategies based on genetic testing results, addressing deficiencies or imbalances that may exacerbate headache conditions.
• Assess the benefits and limitations of using nutrigenomic testing to guide clinical decision-making for headache management and prevention, highlighting the importance of personalized nutrition in improving patient outcomes.

• List the major divisions and subcomponents of the neurological examination. 
• List, contrast and compare the neurological signs associated with “release phenomenon” and “deficit phenomena”.
• Contrast and compare the effects of neurological lesions on the neurological examination of the central nervous system versus the peripheral nervous system.
• Recite the implications of neurological examination findings on disorders involving various components of the central and peripheral nervous system.
• Draw the anatomy of the lower motor neuron in its relation to the spinal cord, nerve root, spinal nerve, and the neuro-myal junction.
• Describe the physical positioning of the patient during aspects of the neurological examination.
• List the subjects to question when in taking a good patient history.
• Describe and perform aspects of the neurological examination of the Cranial Nerves of the patient.
• Draw the neurologic pathways associated with the eye light reflexes.  Include reference to cells of the retina, the optic nerve, the optic chiasm, the optic tract, the Pretectal nucleus, and the Edinger Westphal nucleus.
• Describe and perform aspects of the neurological examination of the Motor Systems of the patient.
• Describe and perform aspects of the neurological examination of the Sensory Systems of the patient.
• Recite findings related to neurological “drift” performed during the neurological examination.
• Describe and perform aspects of the neurological examination of the Reflex Systems of the patient.
• Illustrate components of the muscle stretch reflex including the role of the Alpha motor neuron, Gama motor neuron, and large sensory fibers in relation to the muscle fibers and spinal cord.
• Discuss the common shorthand used for grading muscle stretch reflex responses and discuss the results of the neurological examination associated with each grade.
• Perform and discuss three versions of the extensor plantar response (extensor toe sign, Babinski sign).
• Describe and perform aspects of the neurological examination of movement of the patient.

• Identify exercise physiology concepts related to core conditioning
• Determine the anatomy related to the core and its function in core strength
• Design and implement a core conditioning program
• Summarize the role of psychological motivation in core conditioning
• Examine the various movements associated with core conditioning

Hour one:

• Discuss overall picture of degenerative conditions of the spine
• Develop a differential diagnosis for arthritic conditions of the spine
• Discuss in detail the structural components of the disc
• Learn how the components are involved in the degenerative processes.

Hour two:

• Understand the standard nomenclature
• Classify disc lesions (herniations, etc.)
• Demonstrate types of disc lesions on imaging modalities (x-ray, MRI, CT and Myelogram).

Hour three:

• Demonstrate degenerative conditions on imaging modalities (x-ray, MRI, CT and myelogram)
• Discuss in detail degenerative conditions of the neural arch components
• Describe long term effects of degeneration (stenosis, spondylolithesis)
• Discuss marrow changes associated with degenerative conditions.

• Discuss the pertinent anatomy of foot and ankle of adult and pediatric patient
• Take alignment measurements of the foot and ankle
• Discuss the relevance of alignment measurements to practice
• Assess imaging examples of representative cases

• Examine the appearance and use of plain film, computed tomography (CT), and magnetic resonance imaging (MRI) in the evaluation of bullets to the head.
• Identify Arnold-Chiari Type I malformation with magnetic resonance imaging.
• Review CT, positron emission tomography (PET), and MRI findings for cerebral bleeds.
• Evaluate stroke using different types of CT and MRI imaging.
• Discuss what to look for clinically and radiographically in cases of child abuse induced head trauma.

• Discuss the pertinent anatomy of the forearm, wrist and hand
• Differentially diagnose disorders of each location of the wrist
• Assess imaging findings of representative cases in the list of differential diagnosis
• Quantify and access different imaging modalities and gauge their use in evaluating wrist pain

• Conduct and evidence-based assessment of the diagnostic, therapeutic and clinical utility of routine and repeat radiographs (without red flags) for the structural and functional assessment of the spine by chiropractors
• Summarize the current evidence for the use of spinal x-rays within chiropractic practice, with consideration to the related risks and benefits
• Determine if diagnostic imaging influences clinical outcomes in patients with low back pain presenting for chiropractic care
• Analyze whether an association between vertebral endplate structural defects and back pain exists
• Assess the relationship between movement-related pain in the shoulder and the number or severity of rotator cuff MRI findings

• Discuss meniscus anatomy with emphasis on collagen network.
• Identify how collagen network can predict the type of tear and imaging manifestations.
• State how root ligaments are involved in injury, pain and OA.
• Correlate certain types of meniscal dysfunction to clinical presentation

• Discuss the anatomy of hip and anterior pelvis.
• Diagnose dysfunction and pathologies of the hip and anterior pelvic structures.
• Order appropriate imaging and clinically correlate findings with conditions affecting the hip and anterior pelvis conditions.

• Recite statistics relative to bone lesions.
• Utilize the global approach to recognizing bone lesions.
• Recognize parameters of classifying bone lesions.
• Discuss examples of different classes of bone lesions.