Panama Chiropractic Continuing Education

• Apply contemporary rehabilitation strategies for anterior cruciate ligament patients
• Illustrate the importance of proximal stability and rehabilitation in patients with patellofemoral pain syndrome
• Outline the relationship between quadriceps strength, proprioception and knee osteoarthritis
• Discuss the potential value of gait retraining for improving lower limb biomechanics in runners with patellofemoral pain
• Contrast lower extremity kinematics & muscle activation in patients with and without patellofemoral pain syndrome

• Discuss a proposed model for the logical sequence of active rehabilitation
• Review ‘the core’, its healthy functional role and how it is commonly changed in people with spinal and pelvic girdle pain syndromes
• Describe core muscle activity during physical fitness exercises
• Provide an introduction to dynamic neuromuscular (core) stabilization and athletic performance
• Introduce the basics of exercise prescription

• Illustrate the effects of external pelvic compression on the passive, active and neuromotor control systems of the lumbopelvic region and thigh
• Summarize the importance of core stability assessment and rehabilitation in lumbosacral radiculopathy cases
• Assess the differences in torso motion and muscle activity between elliptical trainer use and treadmill walking
• Discover how even small amounts of daily exercise can positively impact patients with neck and shoulder pain
• Critique and apply periodization concepts to rehabilitation for patients with non-specific low back pain

• Outline the relationship between exercise and brain health
• Describe the evidence for the links between physical activity/exercise and brain function across the lifespan
• Discuss the neurobiology of exercise
• Assess whether exercise is neuroprotective or not
• Summarize the effect of exercise on motor performance

• Identify how the sciatic nerve and adjacent nervous structures respond to tensioning and sliding techniques
• Appraise the potential benefit of adding forward head posture corrective exercise to the management of lumbosacral radiculopathy
• Compare clinical and muscle function outcomes of patients randomized to one of two early multimodal rehabilitation programs following single-level lumbar discectomy
• Analyze the influence of neck strength and muscle activation status on resultant head kinematics after impulsive loading to the head/neck
• Assess the efficacy of corrective exercise interventions for reducing thoracic hyper-kyphosis

• Recognize and document preferred outcomes that result from properly executed active care techniques
• Establish rehab protocols for both cervical and lumbar conditions with suggested core exercise recommendations
• Properly advance a patient through their customized exercise protocol in a systematized fashion
• Identify and document progress on a routine visit basis for patients participating in active care rehab

• Evaluate the long-term effect of exercise therapy in addition to patient education on a patient’s need for total hip replacement (THR)
• Integrate clinical and laboratory research on the function and assessment of abductor muscles about the hip and pelvis 
• Understand how hip weakness can potentially contribute to knee pain and altered running mechanics
• Outline the nomenclature, definition, diagnosis, imaging and management of inguinal disruption (‘Sportsman’s Groin’) 
• Assess the efficacy of exercise interventions for lateral ankle sprains, Achilles tendinopathy and plantar fasciitis 

• Recite 3 risk factors for developing rotator cuff tendonosis
• State the purpose of the scapula reposition and scapula assistance test.
• Explain how to perform the external rotation lag sign and recall the purpose of this test
• Paraphrase one evidence - based test cluster for diagnosing a rotator cuff tear.
• Recall two indications/goals for performing posterior glenohumeral joint mobilizations.
• Cite the clinical prediction rule (CPR) for favorable outcome in patients undergoing conservative management for rotator cuff disorders
• Identify two criteria for phase I rehabilitation exercises for rotator cuff disorders

• Recall 3 potential reasons, based on expert opinion, that may contribute to the high re-tear rate following rotator cuff repair.
• Recite 4 factors that impact the rehabilitation program for patients following rotator cuff repair.
• Summarize the DeOrio classification for rotator cuff tear size.
• State 3 appropriate exercises during weeks 0-2 following rotator cuff repair
• Provide 2 appropriate exercises during weeks 6-8 following rotator cuff repair
• Name 3 appropriate exercises during weeks 8-12 following rotator cuff repair

• Enumerate three physical / clinical examination findings associated with rupture of the quadriceps tenon.
• List 3 patient specific factors that need to be considered when following a rehabilitation program following repair of the quadriceps or patella tendon.
• Recall three goals during phase 1 (0-2 weeks) of a rehabilitation program following repair of the quadriceps or patella tendon.
• Identify three goals during phase 3 of a rehabilitation program following repair of the quadriceps or patella tendon.
• Cite five return to play criteria that need to be met following repair of the quadriceps or patella tendon.

• Summarize the key difference between the cartilage restoration vs cartilage reparation procedures.
• List 3 personal (health and demographic) factors that need to be considered when following a rehabilitation program following cartilage restoration/reparative procedures.
• Enumerate 3 lesion-specific factors that need to be considered when following a rehabilitation program following cartilage restoration/reparative procedures.
• Recall three goals during phase 1 (0-2 weeks) of a rehabilitation program following cartilage restoration/reparative procedures.
• Cite five return to play criteria that need to be met following cartilage restoration/reparative procedures.
• Summarize the evidence-based outcomes for the 3 most common cartilage restoration/reparation techniques.

Hour 1

• Recall 2 pathological pitching mechanical patterns that may lead to injury
• List 3 injury risk factors in in the overhead athlete
• Provide 4 injury prevention screening tests for the overhead athlete
• With respect to shoulder strength, cite 3 metrics  that can be used as red flags to identify players who are at higher risk for incurring an injury to the shoulder /elbow

• Recall 2 pathological pitching mechanical patterns that may lead to injury
• List 3 injury risk factors in in the overhead athlete
• Provide 4 injury prevention screening tests for the overhead athlete
• With respect to shoulder strength, cite 3 metrics  that can be used as red flags to identify players who are at higher risk for incurring an injury to the shoulder /elbow
• Describe 1 clinical test to evaluate anterior and posterior shoulder instability
• List the 3 components of an evidence -based test cluster  to assess rotator cuff pathology in the overhead athlete
• Identify 2 components in the rehabilitation program for shoulder instability
• List and define the 3 types of shoulder impingement
• Recall 2 Performance factors in pitching
• Cite 2 return to play criteria for the overhead athlete
• Identify one advantage of weighted ball holds
• Identify one disadvantage of weighted ball programs

• 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.
• 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.
• 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

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.

• 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