Panama Chiropractic Continuing Education

Hour 1

• Recall the most common types of lumbar spine injuries among athletes participating in different sports.
• Identify one advantage and one disadvantage of the treatment-based classification system as it applies to the treatment of the athlete’s lumbar spine.
• List 3 contemporary treatment models that can be applied to the management of lower back pain in the athlete.

Hour 2

• Recall the definition and importance of red and yellow flags during the medical screening process.
• Identify 3 red flags that may implicate a non-mechanical source of lower back pain.
• List the difference between central and peripheral sensitization.

Hour 3

• List one treatment goal in phase 2 rehabilitation of the athlete’s lumbar spine.
• Cite one treatment principle in phase 3 rehabilitation of the athlete’s lumbar spine.
• Summarize two variations of the squat exercises that can be used to decrease strain on the lumbar spine.
• Recall three variations of the deadlift exercises that can be used to decrease strain on the lumbar spine.
• Summarize the McGill core endurance ratio tests that can be used to guide the return to sport decision making processes

• Recall two important functions of the fascial system.
• Cite 3 factors which impact the mechanical properties of fascia.
• State one structural/ anatomical difference between the fascia of young vs. older individuals.
• List two ways that fascial training can cause remodeling of the fascia.

• Appraise the latest research in terms of the incidence of ACL tears and re-tears.
• Identify the factors associated with higher ACL tear and re-tear rates based on gender and age.
• Describe the importance of “Prehabilitation” programs and their significance on outcomes.
• Analyze the reasons why non-contact knee injuries are the bulk of the problem while listing the biomechanical reasons why non-contact injuries are more prevalent.
• Discuss the objectives of early Phase 1 and Phase 2  rehabilitation protocols while outlining the criteria to be achieved for satisfactory transition from one phase to the next 
• List the objectives of Phase 3 of the rehabilitation protocol and be able to identify potential common faulty movement patterns and compensatory strategies.
• Assess, identify, and address potential limitations in mobility and stability of key core and lower extremity body regions to normalize faulty movement patterns and compensatory strategies.
• List the objectives for phase 4 of the rehabilitation protocol and provide examples of the higher-level movement patterns and compound strengthening exercises incorporated into the program.
• Identify the four common motor performance/neuromuscular imbalances associated with jumping and landing resulting in increased risk
• Describe the identifiable and modifiable risk factors associated with knee injuries and understand how to correct them via exercise and training.
• Recognize the criteria associated with the Return to Sports phase of the rehabilitation program
• Be aware of the complications and adverse events after ACL reconstruction
• Appraise the latest research in terms of common and uncommon complications/adverse events.
• Identify risk factors for the various complications.
• Describe the evaluation and assessment elements needed to identify the various complications
• Based on the evaluation/assessment data, identify and address intervention strategies for each of the complications/adverse events

• Outline the evidence regarding rehabilitation interventions following anterior cruciate ligament (ACL) or meniscal injury
• Evaluate the effectiveness of rehabilitation interventions for patients who have undergone anterior cruciate ligament reconstruction surgery 
• Examine the comparative effectiveness of surgery versus rehabilitation treatments after an anterior cruciate ligament (ACL) rupture 
• Compare the effectiveness of exercise therapy with non-steroidal anti-inflammatories (NSAIDs) and opioids for the management of pain in patients with knee osteoarthritis 
• Determine the patellofemoral joint reaction forces during everyday activities, therapeutic exercises, and physical interventions in healthy individuals and those with patellofemoral pain or osteoarthritis

• Delineate the effects of spinal fixation on degeneration in relation to the chiropractic model of degeneration
• Determine the benefits of 3 common treatments thought to aid chronic spine pain including chiropractic
• Outline and categorize the neurophysiology of spinal manipulation
• Determine the effects of spinal manipulation and exercise on neck pain

• Discuss the epidemiologic evidence and debate about work-related musculoskeletal disorders
• Discuss the costs and financial burden associated with musculoskeletal disorders
• Discuss the factors involved in strain-induced injury of skeletal muscles
• Discuss the inflammatory process as related to musculoskeletal disorders

• Summarize the relation between neural plasticity, LBP and spinal manipulation
• Discuss the concept of intervertebral dysfunction with respect to paraspinal muscle
• Assess the correlation between back pain, disability and quality of life
• Describe a study implementing whole spine manipulation in primary care

• Summarize the dose-response relationship between chiropractic and LBP
• Discuss the differences between chiropractic adjustments and muscle relaxants for LBP
• Assess the relationship between osteopathic manipulation and prenatal outcomes
• Describe the association (or lack thereof) between spinal manipulation and lumbar disk herniations
• Analyze the results of a study on active care vs. manual therapy with active care

• Determine the effects of maintenance chiropractic care on chronic low back pain
• Delineate the demographic and clinic-related predictors for successful outcome of chiropractic patients with low back pain
• Compare individuals with and without chiropractic coverage
• Summarize the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes
• Determine the effects of simulated spinal manipulation on facet joint strains

• Describe the principles of health behavior change
• Detail the factors that promote positive lifestyle changes
• Discuss current theories and models of behavior change
• Discuss techniques and processes of how to change health behavior

• Review articles addressing the latest information concerning chiropractic and/or spinal manipulation for neck pain and/or headaches
• Provide evidence-informed practice recommendations for the chiropractic treatment of headache in adults
• Determine the short-term effect of chiropractic joint manipulation therapy (CMT) and low-level laser therapy (LLLT) on pain and range of motion in the management of cervical facet dysfunction
• Assess whether adjusting dysfunctional cervical segments in people with subclinical neck pain can improve their upper limb joint position sense accuracy
• Investigate the efficacy of preventive spinal manipulative therapy (SMT) compared to a no treatment group in non-specific neck pain patients
• Assess the effectiveness of thoracic manipulation (TM) on patients with chronic neck pain
• Describe a randomized controlled trial comparing manipulation with mobilization for recent onset neck pain

• Review articles addressing the latest information concerning chiropractic and/or spinal manipulation of the lower back
• Assess the current scientific literature related to manipulation for acute low back pain
• Assess the current scientific literature related to manipulation for chronic low back pain
• Compare the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar disk herniation (LDH)
• Review the Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study
• Assess maintenance spinal manipulation therapy for chronic non-specific low back pain

• Review articles addressing the latest information concerning chiropractic and/or spinal manipulation for pregnancy related low back pain and/or post-partum pain
• Review the published evidence regarding chiropractic care, including spinal manipulation, for pregnancy-related low back pain (LBP)
• Describe the clinical outcomes of patients with pregnancy-related lumbopelvic pain (PRLP) treated according to a diagnosis-based clinical decision rule
• Assess osteopathic manipulative treatment of back pain and related symptoms during the third trimester of pregnancy
• Describe the development a clinical prediction rule (CPR) for identifying postpartum women with low back pain (LBP) and/or pelvic girdle pain (PGP) whose functional disability scores improve with a high-velocity thrust technique (HVTT)

• Discuss recent research on Chiropractic Manipulative Therapy for patients with 'Acute Low Back Pain'
• Discuss recent research on Spinal High-Velocity Low Amplitude Manipulation in Acute Nonspecific Low Back Pain
• Review The Quality of Reports on Cervical Arterial Dissection following Cervical Spinal Manipulation
• Describe the Various Mechanisms of Injury in Whiplash Associated Disorders
• Review the Mechanisms of Chronic Pain from Whiplash Injury

• Review methods used by chiropractors to determine the site for applying manipulation
• Review clinical decision rules, spinal pain classification and prediction of treatment outcome in rehabilitation literature
• Describe the trajectories and life course of low back pain
• Discuss the evidence for multisite musculoskeletal pain being common among people suffering from low back pain
• Discuss the relative effectiveness of manipulative therapy vs sham manipulation

• Discuss how spinal manipulation can lead to neural plastic changes involving cortical drive and the H-reflex pathway
• Assess the impact of cervical spinal manipulation on heart rate variability
• Assess how somatosensory evoked potentials (SEPs) can be used to elucidate differences in cortical activity associated with a spinal manipulation (SM) intervention
• Describe alterations in cortical and cerebellar motor processing in subclinical neck pain patients following spinal manipulation
• Apply the effect of spinal manipulation on somato-sympathetic reflexes

• Describe muscle activity patterns in pain development and alleviation
• Discuss the role of anti-inflammatory interventions and their effect on skeletal muscle injury as they pertain to chiropractic examination/treatment
• Assess whether the construct of myofascial pain syndrome caused by trigger points is conjecture
• Review recent fascia research as it pertains to anatomy and biomechanics
• Summarize anatomical and biomechanical properties of fascial tissue with a special focus on fascial dysfunctions and resulting clinical manifestations

• Describe the effect of intervertebral facet joint fixation and segmental thrust level on paraspinal muscle spindle activity
• Determine how contact site for high velocity, low amplitude spinal manipulation affects sensory input to the central nervous system
• Assess the association between low-tech clinical tests commonly used in adult patients with acute, recurrent or chronic LBP and short- and long-term outcome
• Discuss the role for neck manipulation in elderly falls prevention
• Summarize North American chiropractic students’ opinions concerning professional identity, role and future

• Assess whether low back pain (LBP) patients who respond to spinal manipulative therapy (SMT) differ biomechanically from non-responders and untreated asymptomatic controls
• Describe the comparative effectiveness of manipulation versus usual medical care for acute and subacute low back pain
• Determine the effectiveness of adding upper cervical manipulation to a multimodal program for patients with fibromyalgia
• Discuss the effects of forward head posture correction in patients with chronic discogenic lumbosacral radiculopathy
• Summarize US chiropractors' attitudes, skills and use of evidence-based practice

• Review the literature for cases of adverse events in infants and children treated by chiropractors or other manual therapists
• Analyze provider specialties in the treatment of patients with back and joint problems
• Review the role of the cervical spine in post-concussion syndrome
• Assess whether the availability of chiropractic care affects use of primary care physician (PCP) services
• Describe the effect of chiropractic treatment on gastrointestinal (GI) disorders

• Asses the differences in primary and secondary clinical outcomes between monodisciplinary chiropractic care and multidisciplinary integrative care for sub-acute and chronic low back pain 
• Evaluate the expectations of patients with low back pain and compare these to the assumptions of physicians 
• Compare the efficacy of thrust and non-thrust spinal manipulation in adults with subacute or chronic low back pain
• Describe the prognosis, pain intensity and proportion of participants seeking care following an acute episode of low back pain in a community cohort 
• Investigate the relationship between specific psychosocial factors and severe pain and functional limitation in patients with low back pain

• Summarize contemporary clinical and evidence-based data relating to cervical spine involvement in tension type headaches
• Explore the relationship between neck pain and migraine headache, as well as ways we can use clinical information to appropriately manage our patients
• Assess the effectiveness of various manual therapy techniques in the treatment of cervicogenic headache
• Outline the efficacy of various interventions on the intensity, frequency, and duration of pain in cervicogenic headache
• Compare the effects of thrust spinal manipulation and electrical dry needling versus non-thrust spinal mobilization and exercise in patients with cervicogenic headache

• Identify characteristics that are associated with chiropractors receiving referrals from general practitioners
• Summarize and evaluate the evidence comparing the cost of chiropractic care with conventional medical care for management of spine related musculoskeletal pain
• Assess the impact of initial provider type on treatment patterns for neck pain
• Evaluate the relationship between lumbar spinal manipulation dose and exposure to escalated spine care
• Investigate the relationships between the use of active, passive, and manual therapy interventions for the management of patients with low back pain and subsequent escalation-of-care events

• Summarize best practice recommendations for the chiropractic management of pediatric patients
• Evaluate quantitative and qualitative evidence relating to the rehabilitative management of low back pain in children and adolescents aged 19 years or younger
• Elucidate the association between any form of adverse childhood experience and various types of chronic pain in adults
• Identify the ways growing pain(s) are defined in peer-reviewed literature and diagnostic systems

• Define Fibromyalgia according to the ACR criteria
• Discuss the history and epidemiology of Fibromyalgia
• Assess the differential diagnoses, triggers and possible causes of Fibromyalgia and discuss how they can help in the diagnosis of Fibromyalgia
• Identify several triggers for the exacerbation of Fibromyalgia
• List the symptoms of depression, grief and adjustment disorder that can be clues for the diagnosis of Fibromyalgia
• Recall the symptoms of dysfunctional sleep, chronic pain and fatigue that help to diagnose Fibromyalgia
• Compare some of the triggers that may make pain worse in the Fibromyalgia patient and factors that may decrease pain in the Fibromyalgia patient

• Define Rheumatology and Chiropractic and list similarities
• Critique some of the downfalls in today’s treatment protocol of the Rheumatic patient and explain why Chiropractors should be aware of this patient population
• Discuss Integrative Medicine and outline some of the important options for holistic treatment
• Discuss other health concerns facing the Rheumatic Patient
• List the steps used in evaluating the Rheumatic Patient
• Identify some of the tools used for diagnosis and treatment of the Rheumatic Patient
• Analyze the patient’s symptoms and test values and compare for differential diagnose
• Evaluate laboratory tests and values used to diagnose Rheumatic diseases and syndromes
• Select the best imaging techniques for specific Rheumatic diseases and soft tissue syndromes
• Identify some of the diseases specific issues in a few of the Rheumatic diseases and syndromes discussed
• Recognize the symptoms, diagnosis protocols and treatments of some of the more prevalent arthritic diseases and syndromes

• Construct a list of four specific compliance risk areas for physicians
• Establish internal control mechanisms
• Distinguish aspects of Quality Assurance
• Develop Documentation Principles
• Identify documentation warning signs and components of SNOCAMP

• Review important laws, rules and regulations related to the Georgia Workers' Compensation Act
• Develop an understanding of the rights and responsibilities of the parties and a working knowledge of the Georgia Workers' Compensation Act
• The Georgia chiropractor will expand and/or update current knowledge base relating to the Georgia Workers' Compensation Act and treatment

• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to malpractice
• Minimize risks and failure in malpractice actions
• Encourage development and nurturing of skill sets in avoiding malpractice actions
• Identify action steps for minimizing risks of malpractice actions

• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to informed consent
• Minimize risks and failure in malpractice actions
• Encourage development and nurturing of skill sets in avoiding malpractice actions by utilizing properly executed informed consent
• Identify action steps for minimizing risks of malpractice actions