• Discuss different types of lumbar stretching and their effects.
• Define therapeutic stretching goals, protocols and precautions for the lumbar spine.
• Measure lumbar pain, agility and joint crepitus associated with therapeutic stretching.
• Apply lumbo-pelvic circumduction training to improve disc related joint mobility.
• Integrate PreActive therapeutic stretching techniques to reduce lumbo-pelvic muscle tension.
• Devise strengthening protocols for the lumbo-pelvic region using graduated isometric protocols.
• Discuss mobility during lumbar traction to reduce disc pressure.
• Compare static traction versus dynamic traction.
• Define contra-indications for decompression therapy of the lumbar spine.
• Apply appropriate lumbar decompression therapy to various patient populations.
• Demonstrate lumbar mobility training exercises used to enhance decompression effectiveness.
• Justify reimbursement through accurate documentation of lumbar disc treatment progression.
• Diagnose lumbar disc conditions with clarity.
• Select outcome-based assessment tools to monitor patient progress.
• Illustrate lumbar range of motion and muscle testing deficiencies concisely.
• Summarize patient status for lumbar mobility, crepitus and pain intensity.

• 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

Hour 1

• Indicate the immune system’s complexity as it fits into the body’s function,
• Give examples of various substances involved with the immune system
• Identify hypersensitivities and their effect on the body
• Review lab studies involving TH1 and TH2 cells

Hour 2

• Discuss signs and symptoms of hypersensitivities
• List different methods of testing and critique their strengths and weaknesses.
• Give an example of a complicating factor that might skew test results
• Review the terms sensitivity and specificity in lab tests

Hour 3

• List 1-2 examples of factors which may result in hypersensitivities
• Explain the effect of smoking
• Discuss the effect of SO2 on health
• Give examples of co-sensitivity

• 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

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

• Differentiate and document for the difference between medical necessity and clinical appropriateness
• Execute a complete and compliant treatment plan that includes all required elements
• Properly record the elements necessary to justify the full-spine adjustment
• Command the mechanics of properly documenting clinical rationale for ordered diagnostics and treatment
• Ensure the inclusion of diagnostic assessment and doctor’s rationale in routine daily visit notes

Hour 1

• Distinguish how orange juice can improve blood lipid profiles
• Discuss dietary aspects for the vegetarian athlete
• Identify the relationship between bromelain and acute inflammation
• Develop the anti-septic activity of tea tree oil
• Describe Probiotics

Hour 2

• Review aspects of antioxidants and free radicals
• Discuss how silymarin can improve an alcohol-damaged liver
• Describe the connection/mechanism between atherosclerosis and vitamin E
• Identify research evidence between whole grains and disease
• Delineate the relationship of magnesium and hypertension

Hour 3

• Identify risk factors of cardiovascular disease
• Construct a list of appropriate food and food groups associated with cardiovascular disease prevention
• Evaluate various supplements that are beneficial in prevention and treatment of cardiovascular disease
• Differentiate various diets in regard to cardiovascular disease

1. Investigate the importance of nutrient deficiencies
2. Review the role of essential nutrients in human health
3. Analyze the interaction between nutrients and various illnesses
4. Ascertain the role herbs have in health and disease
5. Understand drug and nutrient interactions

Hour 1:

Discuss PNI and its relationship to musculoskeletal conditions

Review the interaction of the Hippocampus-Pituitary-Adrenal axis with PNI and its effect on musculoskeletal conditions Discuss clinical approach to managing these syndromes

Hour 2:       

Explain what factors affect the baby boomer population

Establish Patient education and doctor patient relationship

Establish protocols to improve treatment outcomes

Hour 3:

Mind over matter- how the brain and neuropathways affect musculoskeletal conditions

Describe cellular structure connections

Evaluate patients with musculoskeletal conditions and consider the effect of the mind, body, cellular and neurological alterations manifesting of these conditions.

• Point out the anatomy of the upper cervical spine and associated regional anatomy as seen on the APOM
• Identify variants of anatomy on APOM, noting if they are clinically relevant in providing Chiropractic care
• Differentially Diagnosis pathology noted in the region
• Discuss the advantages and disadvantages of imaging modalities for the upper cervical spine and maxillofacial region

Hour 1 — Foundations of Laser-Integrated Adjusting

• Explain innate intelligence and tensegrity principles as they apply to laser-integrated chiropractic adjusting.
• Describe the neurological and biomechanical mechanisms that support combining low-level laser therapy with chiropractic adjustments.
• Analyze why laser-integrated adjusting produces more predictable and reproducible clinical outcomes than adjusting alone.
• Identify the rationale for the laser-integrated adjusting algorithm and differentiate between hardware-based (structural/mechanical) and software-based (neurological/upregulation) clinical protocols.

Hour 2 — The Core Algorithm, Sequencing & Visit-Specific Upregulation Protocols

• Demonstrate the complete laser-integrated adjusting algorithm—Screen → Test → Laser Prime → Adjust—as it applies to a standard chiropractic adjustment visit.
• Apply region-specific laser upregulation protocols—including cervical, thoracic, lumbar upregulation—in conjunction with each chiropractic adjustment.
• Explain the clinical importance of sequencing chiropractic adjustments in the order of supine, sitting, prone, and standing to optimize neurological organization and adjustment stability.
• Integrate proper patient positioning and adjustment sequencing into the laser-integrated workflow to improve efficiency and reproducibility of outcomes.

Hour 3 — Muscle Testing, Region-Specific Protocols & Functional Integration

• Utilize muscle testing to identify subluxation patterns, guide region-specific laser application, and determine appropriate stacking strategies.
• Integrate rib-torque and pubic-bone protocols into laser-assisted spinal and pelvic adjustments to improve structural stability.
• Perform various lower-body stacking procedures using laser-assisted methods.
• Integrate locomotor lock in to reinforce post-adjustment stability, coordination, and neurological organization.

Hour 4 — Integration, Clinical Workflow Design & Monday-Morning Implementation of Primary Bloom’s Levels: Analyze • Create • Evaluate

• Review and synthesize the foundational principles, clinical algorithms, and protocols to reinforce understanding and clinical coherence.
• Design a streamlined clinical workflow that incorporates laser-integrated adjusting without increasing visit time, while maintaining efficiency and reproducibility.
• Evaluate how laser-integrated adjusting expands clinical applications of existing low-level laser systems within routine chiropractic care and including services in patient care plans.
• Deliver a patient experience that demonstrates observable functional improvements through movement-based assessment, providing variety and clinical relevance with each adjustment.

• Outline the nature of and hallmarks of cancer
• Summarize the relationship between physical activity and cancer
• Summarize the relationship between nutrition and cancer
• Summarize the relationship between massage therapy and cancer
• Summarize the relationship between acupuncture and cancer
• Summarize the relationship between manual therapy and cancer

• Identify various energy systems of the body and how they relate to exercise and sport
• Theorize which energy system is used for a specific sport event/activity
• Summarize the physiology of fat, protein and carbohydrate metabolism and utilization in exercise and sport
• Understand the relationship between the energy systems and various exercise parameters
• Create a diet protocol for the athlete prior to their sport or exercise activity
• Determine and understand the timing of meals in exercise and sport
• Outline a useful program for a person to maximize carbohydrate stores
• Theorize how glycemic index can affect exercise and sport activity
• Ascertain differences between food variables and how they affect exercise and sport performance

• 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.