• Describe the anatomy and biomechanical function of the first MTP sesamoid complex, including how these structures contribute to weight distribution, force generation, and joint stability throughout the gait cycle.
• Perform a comprehensive clinical examination and interpret radiographic findings to accurately diagnose sesamoid pathology and differentiate between bipartite sesamoids and fractures.
• Develop and implement conservative management strategies using orthotics, taping, strengthening exercises, and adjunctive modalities to address sesamoid-related pain and dysfunction.
• Explain the consequences of sesamoid pathology and degenerative changes (including hallux valgus complications) on first MTP joint stability, cartilage integrity, and functional alignment.
• Evaluate surgical options and their outcomes, including the indications, advantages, and serious complications (particularly bilateral sesamoidectomy consequences) when conservative management fails.
• Apply biomechanical principles to address associated forefoot pain syndromes through footwear modifications, orthotic design, and gait training strategies.

Educational Objectives: for Documentation

Hour 1 and 2

• Identify the correct amount of time a chiropractic record must be maintained with specific differences for that of an individual under the age of 18 as well as records related to a civil, criminal or administrative proceeding
• Keep appropriate records and maintain required information and provide requests for information and records from licensee’s.
• Describe various types of patient encounters and levels of documentation, and determine how to properly document each encounter.
• List the various governing bodies and organizations which may impose requirements on your record keeping of the patient’s health chart.
• Identify key components of the office entry forms and relate the importance of follow up and systems review.
• Compare and contrast various outcome assessment instruments, describe the importance of these tools and properly use and score various outcome assessment instruments.
• Recite tests traditionally thought of as objective and tests traditionally thought of as subjective in the context of reliability and validity.
• Define the characteristics of a good outcome assessment tool, and be able to properly implement it in clinical practice.
• Compare and contrast the various types of electronic health records available.
• Itemize the requirements of a “paperless” office.

Educational Objectives: for Ethics

Hour 3

• Identify legal prohibitions against promising healthcare cures, guaranteeing treatment results, and deceptive patient communication.
• Distinguish between appropriate and inappropriate communication relating to patients' healthcare prognoses and progress.
• Explain scientific literature linking patients' mental states with healthcare outcomes.
• Demonstrate alignment between compliance with states' current patient communication restrictions and instances of patient encouragement that foster mental states favorable to desired healthcare outcomes.
• Explain office procedures and staff training which are likely to ensure ongoing ethical patient communication and the documentation thereof.

Educational Objectives: for Risk Management

Hour 4

• Appropriately disclose charges to patients
• Identify potential problems associated with sharing fees with non-healthcare professionals.
• Demonstrate anti-trust issues associated with setting professional fees
• Explain connections between co-pay waivers and violations of the False Claims Act
• Describe the appropriate delegation of authority in a Chiropractic office to avoid licensure complaints
• Assess parallels between fee-splits and principles of ostensible agency that can lead to malpractice liability.
• Compare and contrast fee-splitting and the corporate practice of medicine.
• Legally provide Prepaid Treatment Plans

• Analyze the role between diet and the immune system
• Design a nutrition supplement program to stimulate the immune system
• Develop a nutrition program for colds, flu, sore throat and infections
• Understand basic detoxification techniques
• Examine the role of nutrition and diet in regards to chronic fatigue syndrome

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.

• Describe the fundamental principles of MRI physics and the key cervical spine imaging sequences (T1, T2, STIR) relevant to chiropractic practice.
• Identify normal cervical spine anatomy and recognize common pathological MRI findings such as disc herniation, stenosis, and myelomalacia.
• Interpret MRI findings in correlation with clinical symptoms to guide safe chiropractic decision-making and patient management.
• Differentiate between MRI indications, contraindications, and safety considerations to determine when referral for MRI is appropriate.
• Communicate effectively with radiologists, patients, and insurers using MRI-based terminology and objective evidence to support clinical and medico-legal documentation.

Educational Objectives: for Documentation portion:

Hour 1 and 2

Educational Objectives:  Documentation

• Discuss key items related to the OIG reports regarding chiropractic services
• Discuss Executive Order issued by the White House titled reducing improper payments and eliminating waste in Federal Programs
• Discuss what triggers an audit and key items to consider if audited
• Discuss Medicare’s guidelines for necessity of chiropractic care as it relates to covered services, x-ray/diagnostic reimbursements, Quality Payment Program (QPP), diagnosis coding requirements and Medicare’s appeals process  
• Discuss appropriate use of modifiers
• Discuss Medicare’s documentation requirements when utilizing Medicare’s ABN (Advanced Beneficiary Notification) form
• Recognize the key components regarding good documentation and record keeping
• Identify the legal requirements of informed consent and the key elements of the informed consent process
• Discuss why doctors are held to higher standards
• Describe the 21 NCQA guidelines for record keeping
• Document progress notes (SOAP) to meet insurance guidelines and medical necessity
• Apply the PARTS system and its transformation utilizing a new method AIR S & M
• Utilize CMT coding appropriately

Educational Objectives: for Ethics

Hour 3

• Perform communication with patients and the public at large such that it informs, instructs and doesn't mislead.
• Discuss the parallels between accurate communication and ethical conduct.
• Administer healthcare practice compliant with HIPAA, state confidentiality statutes, and relevant rules, regulations and state court cases applicable to patient confidentiality.
• Comprehend the commercial, regulatory, social and familial interests seeking to obtain and/or are served by the release of patient information.
• Develop effective office systems and policies for securing and documenting patients’ informed consent
• Appropriately disclose charges

Educational Objectives: for Risk Management

Hour 4

• Assess court and Office of Inspector General rulings relating to anti-kickback restrictions.
• Demonstrate how anti-kickback and Stark legislation is both viewed and enforced by relevant professional boards and state and federal enforcement agencies to avoid fraud
• Explain how to avoid misleading claims
• Identify specific conduct and activities within the practice of healthcare that violate a host of regulatory and statutory proscriptions relating to patient referral arrangements.
• Properly Delegate authority in your office
• Identify parallels between Stark self-referral laws and anti-kickback restrictions.

• 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

• Discuss the prevalence of osteopenia and osteoporosis.
• Describe the relationship between osteoporosis and fragility fracture.
• Contrast the relationship between fragility fracture, morbidity and mortality.
• Differentiate the differences between cortical and trabecular bone.
• Recognize the osteoporosis “care gap” and its driving factors.

• Summarize the bone remodeling cycle.
• Discuss the changes in the bone remodeling cycle with age.
• Discuss the role of declining estrogen in the age-related changes in bone remodeling.
• Discuss the areas of the bone remodeling cycle that allow therapeutic interventions.

• Apply best practices for using abbreviations, addressing legibility, authentication of signatures, and managing the day-to-day flow of your patient records 
• Clearly delineate the beginning and end of episodes of patient care, proper recording of these episodes, and boundary discussions with patients 
• Locate and utilize the definitions of medically necessary care, and apply it as a differentiator from clinically appropriate care
• Assess documentation across the life cycle of the patient’s chart from history to discharge and on through maintenance and wellness care based on live examples demonstrated
• Identify the deficiencies that may be present in your documentation through the eyes of an auditor

Hour 1 and 2: Nutrition and the Gastrointestinal System

1. Understand the importance of normal bowl defense mechanisms
2. evelop a nutritional treatment for candidiasis and gut flora imbalances
3. Examine the importance of fiber on human health
4. Design a nutritional treatment program for constipation and diarrhea
5. Develop an appropriate nutrition program for an ulcer
6. Identify the importance of diet in Celiac?s disease (non-tropical sprue)
7. Outline a nutrition program for a patient with lactose intolerance
8. Design a nutrition treatment program for GERD
9. Examine the role of nutrition and supplements in irritable bowel syndrome

Hour 3: Nutrition and Sugar Imbalances

1. Review the clinical presentation of Diabetes
2. Examine the role of nutrition and diet in Diabetes
3. Design an appropriate supplement protocol for the diabetic patient
4. Develop nutritional guidelines for hypoglycemia

• Recognize normal thoracic spine MRI anatomy and accurately distinguish it from common pathological findings relevant to chiropractic practice.
• Discuss the fundamental principles of MRI image acquisition, interpretation, and signal characteristics (T1, T2, STIR) as they apply to the thoracic spine.
• Identify common thoracic spine pathologies—including degenerative disc disease, herniations, stenosis, fractures, and myelopathy—on MRI and relate them to patient presentation.
• Apply MRI findings to develop safe, evidence-based chiropractic treatment plans and determine when imaging results warrant modification of care or referral to another provider.
• Integrate MRI knowledge into clinical communication by effectively discussing imaging results with radiologists, other healthcare professionals, and patients to support interdisciplinary collaboration.

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

• Define hallux limitus
• Discuss the biomechanics of hallux limitus
• Perform differential diagnoses of hallux limitus
• Apply rehabilitation strategies for hallux limitus
• Utilize orthotic therapy and hallux limitus

Nutrition

• Develop components of a typical healthy meal plan for athletes
• Differentiate between healthy and unhealthy food choices in each category of FAT, CHO, PRO
• Identify problem foods specific to the individual athlete
• Explain CHO loading and examples of high glycemic index foods
• Describe meal plan for post-exercise "window of recovery"
• Describe benefits and sources of branched chain amino acids for athletic recovery
• Explain purpose of omega 3 fatty acids during recovery phase of athletic activity
• Define components of female athlete triad
• List vitamins and minerals required to rebuild bone health in female athlete triad
• Name ergogenic nutrients acceptable to the World Anti-Doping Agency

Dehydration

• Explain difference between dehydration and hyponatremia
• Recognize early or acute signs and symptoms of dehydration and hyponatremia
• Discuss benefits of each method of determining hydration status
• Demonstrate treatment intervention for heat cramps
• Compare energy drink to sports drink

• 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

Educational Objectives: for Documentation portion:

Hours 1 and 2

• Recognize the key components regarding good documentation and record keeping
• Identify the legal requirements of informed consent and the key elements of the informed consent process
• Discuss why doctors are held to higher standards
• Describe the 21 NCQA guidelines for record keeping
• Document progress notes (SOAP) to meet insurance guidelines and medical necessity
• Apply the PARTS system and its transformation utilizing a new method AIR S & M
• Utilize CMT coding appropriately
• Utilize E/M (Evaluation/Management) coding appropriately to meet insurance guidelines and medical necessity
• Identify the 3 categories and 2 subcategories of E/M codes
• Identify the 4 levels of E/M services for new and established patients
• Recognize the importance of a medically appropriate history and physical exam
• Identify the 2 key elements used to determine the level of E/M service
• Select the appropriate level of E/M services utilizing 4 simple steps

Educational Objectives: for Ethics

Hour 3

• Identify challenging/inappropriate patient requests and behaviors encountered by chiropractors.
• Explain prevention strategies, office procedures and effective responses to inappropriate patient activity.
• Describe safety concerns associated with a patient's inappropriate acts and communications, as well as ethical principles related thereto.
• Illustrate legal and ethical issues arising where the doctor/patient relationship is terminated due to inappropriate patient behavior.
• Analyze how aberrant patient behavior presents risks to staff, the treating doctor, and to fellow patients, and how proper documentation is important in such instances.

Educational Objectives: for Risk Management

Hour 4

• Comprehend the association between the doctor-patient relationship and the charge of patient abandonment.
• Evaluate the role voluntariness plays in the establishment of the doctor-patient relationship, in informed consent, and in abandonment as associated with the inappropriate termination of the professional relationship.
• Contrast and compare "ostensible agency" with "voluntary association" for purposes of assessing potential patient malpractice liability.
• Comprehend the requirement for the continued administration of healthcare for purposes of determining possible patient abandonment issues.
• Carry out proper documentation as demonstrates non-existence of abandonment.
• Effect policies that systematize screening of non-compliant patients and execute relevant medical record documentation to ensure no patient is legally "abandoned."
• Discuss prepaid treatment programs

• Analyze charges and documentation on a daily or per visit basis to ensure accuracy and compliance
• Compile accurate and comprehensive responses to documentation or record requests
• Recognize and avoid confusing HIPAA privacy issues that can cost you time and money
• Identify key areas that lack written policies causing increased risk in the practice
• Evaluate your current written procedures and appraise the need for additional content

• 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

Hour 1

• Examine the role of immunosenescence in background systemic inflammation.
• Discuss the role mesenchymal stem cell senescence in osteoporosis.
• Demonsrate senolytic therapy in eliminating senescent cells in osteoporosis.
• Contrast inflammatory resolution with inflammatory suppression.
• Discuss the role of micronutrients in the prevention and treatment of osteoporosis..

Hour 2

• Discuss the role of vitamins D & K2 and minerals the prevention and treatment of osteoporosis.
• Explain the effectiveness of osteo-inductive nutraceuticals in the treatment of osteoporosis.
• Examine the research on the use of hydrolyzed collagen peptides in bone density and strength.
• Discuss the use of bovine bone morphogenic proteins in osteoporosis.
• Contrast the ability of nutrients, therapeutic modalities and medications in the ability of normalize bone remodeling.

Hour 3

• Examine the role of exercise in the prevention and treatment of osteoporosis.
• Discuss the evidence supporting the efficacy of laser therapy in osteoporosis including in vitro cell studies, animal models and human studies both for fracture and osteoporosis.
• User laser therapy to normalize the bone remodeling cycle in osteoporosis.
• Discuss the cell receptor and signaling pathways in osteoblasts and osteoclasts that are receptive to pulsed electromagnetic frequency (PEMF) therapy interventions.
• Apply the “cross-talk” effect of PEMF therapy on bone.

 Hour 4

• Discuss the evidence supporting the efficacy of pulsed electromagnetic frequency therapy in osteoporosis including in vitro cell studies, animal models and human studies both for fracture and osteoporosis.
• Examine the positive “spillover effect” of laser therapy and PEMF therapy of osteoarthritis in the treatment of osteoporosis.
• Summarize the clinical trials of PEMF therapy for osteoporosis.
• Discuss the importance of pulse frequency in the application of PEMF therapy.
• Examine the comorbidity between osteoporosis and osteoarthritis.