Hong Kong Chiropractic Continuing Education

• Discuss the specific pattern of fibrosis development around and within the plantar myofascia of the foot.
• Discern the effects of the fibrosis and adhesions on the plantar fascia, associated soft tissues and the functional biomechanics of the region.
• Understand the rules of treatment specific to Plantar Fasciitis of the Foot.
• Apply modalities and manual methods to treat fibrosis and adhesions in the soft tissue structures around and within the foot and ankle joint as well as associated contracted muscle tissue.
• Rehabilitate weak and atrophied muscles using stretching, exercise and modalities.

• Justify examination of the cervico-thoracic spinal regions for dysfunction in lateral epicondylalgia patients
• Explain and identify posterolateral rotary instability (PLRI) of the elbow
• Optimize clinical assessment and diagnosis for the long head of biceps complex
• Explore the potential pathological commonalities amongst adhesive capsulitis, metabolic syndrome and low-grade inflammation
• Discuss current neuroanatomical and biochemical theories as they pertain to shoulder pain and its clinical management

• Assess the effectiveness of three nonsurgical interventions on symptoms, physical function, and physical activity in patients with lumbar spinal stenosis.
• Compare the effectiveness of a structured, comprehensive conservative treatment program with a focus on self-management and improved walking ability (including lumbar manipulation, exercise and education) to a self-directed program in patients with neurogenic claudication due to lumbar spinal stenosis.
• Summarize the 2013 North American Spine Society (NASS) clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis.
• Examine the literature pertaining to the diagnostic accuracy of available tests for lumbar spinal stenosis.
• Analyze the effectiveness of the 6-week Boot Camp Program for Lumbar Spinal Stenosis

• Demonstrate an understanding of the epidemiology of fibromyalgia, its impact on patient health, and the clinical controversy surrounding the syndrome.
• Evaluate available treatment options and design a treatment plan for the patient with fibromyalgia.
• Evaluate the available evidence regarding chiropractic manipulation, and complementary and alternative medicine for fibromyalgia.
• Justify the role of patient self-care in the treatment of fibromyalgia.

Hour 1

• Define and apply viscerosomatic reflexes and influences.
• Define and apply somatoviscera reflexes and influences.
• Define and apply psychosomatic reflexes and influences.
• Apply autonomic reflexes to clinical conditions including somatic dysfunction.

Hour 2

• Identify the general nature of pain and its mechanisms including the physiology and psychology of pain.
• Describe the effect of somatic dysfunction on the autonomic nervous system and apply this knowledge to the use of manipulative therapy
• State the definition, location, and identification of Chapman’s points on the body.
• Express Chapman’s points in relation to the major organ systems of the body.

Hour 3

• Illustrate Chapman’s points of the cardiovascular system.
• Illustrate Chapman’s points of the respiratory system.
• Describe management of Chapman’s reflexes in a common clinical scenario.
• Critically appraise, and utilize relevant scientific literature and information to assess and improve patient care practices; and, contribute to the ongoing scholarly development of the chiropractic profession

• Provide an overview of the complex regional anatomy of the shoulder girdle and how this allows the scapula to act as a both a dynamic and static stabilizer to the upper limb.
• Explore the normal biomechanics and the etiology, epidemiology and pathological occurrences which can disrupt the normal function and lead to scapula dyskinesis.
• Summarize the typical scapular dyskinesis clinical assessment which is most likely to identify the source of the pathology and guide the treatment.
• Demonstrate common extremity and shoulder manipulations that may help the patient with scapular dyskinesis.

• Enumerate five physical / clinical examination findings associated with lumbar spinal stenosis
• List 3 essential components of a rehabilitation program for patients with lumbar spinal stenosis
• Recall four flexion-based exercises that are part of a rehabilitation program for a patient with lumbar spinal stenosis
• Identify three common soft tissue mobility impairments associated with lumbar spinal stenosis
• Cite two common joint mobility impairments associated with lumbar spinal stenosis
• Provide two evidence-based exercises that elicit high EMG activity of the transverse abdominis
• Enumerate three evidence-based exercises that elicit high EMG levels of the gluteus medius

• Relate the effects of posture on compression of the cervical cord and nerve roots and use this knowledge to develop decompression exercises for their cervical stenosis patients.
• Decompress the cervical spine utilizing the Cervico 2000 ambulatory traction device.
• Implement a strategy of upper extremity peripheral nerve stimulation to relieve symptoms of cervical spinal stenosis.
• Develop and institute a comprehensive cervical spinal stenosis rehabilitation protocol as a potential alternative to surgery. 

• This contains all courses with the educational objectives listed from Management of Common Conditions 244 through Management of Common Conditions 247

• Discuss relevant anatomy associated with specific injuries to climbers
• Summarize common climbing movements and grip types
• Apply knowledge of relevant anatomy, movement, and grip types in discussing etiology of climbing injuries
• Differentiate common presentations of injuries in rock climbers
• Determine which presentations and etiologies require further interventions such as imaging, surgical consult etc..
• Briefly describe active management strategies and treatment plans for rock climbing injuries

• Summarize the recent NASS clinical guideline on the diagnosis and treatment of low back pain 
• Assess the literature to determine which mode(s) of exercise is/are best for treating chronic low back pain 
• Discuss the comparative effectiveness of currently available treatments for acute and subacute mechanical non-specific low back pain 
• Explore how clinicians can optimally facilitate self-management in patients with back pain 
• Evaluate the effectiveness of Foot Levelers shoe orthotics with and without chiropractic treatment for chronic low back pain as compared with no treatment

• Explain current best practices for the diagnosis and management of Achilles tendinopathy 
• Synthesize the evidence from randomized controlled trials to determine the clinical effectiveness of shockwave therapy, either as a monotherapy or part of a multimodal package of care for chronic mid- and insertional-Achilles tendinopathy 
• Appraise an international, multi-disciplinary consensus statement on return to sport decisions after lateral ankle injuries 
• Outline best practices in the management of plantar heel pain based on the latest evidence 
• Establish the effectiveness of the Nordic Hamstring Exercise for preventing hamstring injuries in athletes

• Explain the biomechanics of the lumbopelvic spine
• Describe the examination of the lumbopelvic spine
• Explain the mechanism of scoliosis
• Describe the pathological conditions of the lumbopelvic spine
• Demonstrate soft tissue treatments for pathological conditions of the lumbopelvic spine  

• Explain the biomechanics of the TMJ
• Describe the examination of the TMJ
• Describe the pathological conditions of the TMJ
• Demonstrate soft tissue treatments for pathological conditions of the TMJ
• Define functional relationships of the TMJ with associated regions

• Explain the biomechanics of the TMJ
• Describe the examination of the TMJ
• Describe the pathological conditions of the TMJ
• Demonstrate soft tissue treatments for pathological conditions of the TMJ
• Define functional relationships of the TMJ with associated regions

• Explain injury and healing of soft tissues
• Perform somatic technique and strain/counterstrain
• Utilize friction massage and post isometric relaxation
• Perform active release and myofascial release
• Apply trigger point ultrasound, exercise, stretching and manipulation

Introduction

• Distinguish the anatomical structures involved in TMJ dysfunction, including the temporomandibular joint, mandible, and associated muscles and the different types of jaw movements and their biomechanical implications.
• Interpret the normal biomechanics of the temporomandibular joint during various jaw movements.
• Identify the key ligaments and soft tissues supporting the temporomandibular joint and the factors that can lead to abnormal biomechanics and dysfunction of the temporomandibular joint.
• Explain the role of muscle imbalances and joint misalignments in TMJ dysfunction.
• Differentiate the relationship between the temporomandibular joint and adjacent anatomical structures.

Examination

• Appraise the various assessment tools used in evaluating TMJ dysfunction, such as patient history, physical examination, and imaging studies.
• Arrange a comprehensive physical examination of the temporomandibular joint, including range of motion assessment, palpation, loading, stressing, and compressing.
• Demonstrate the ability to perform a comprehensive evaluation of TMJ dysfunction and posture, including assessing range of motion, muscle strength, joint stability, and postural alignment.
• Discriminate the indications of differential diagnoses for TMJ dysfunction.
• Analyze the findings from a TMJ dysfunction and posture assessment to formulate an accurate clinical diagnosis.

Mobilization and Adjusting

• Develop a holistic approach to managing TMJ dysfunction, considering both conservative and interventional treatment options.
• Apply specific chiropractic techniques and adjustments aimed at restoring normal joint alignment and function of the temporomandibular joint and about occlusal splints and their use in managing TMJ dysfunction.
• Propose a role of therapeutic exercises and stretching in improving jaw mobility and strengthening supporting muscles and the importance of patient education and lifestyle modifications in the management of TMJ dysfunction.
• Develop a treatment plan for patients with TMJ dysfunction and posture issues, incorporating therapeutic exercises, manual therapy techniques, postural re-education, and other appropriate interventions.
• Evaluate the efficacy of potential benefits and risks associated with various treatment modalities for TMJ dysfunction and posture problems, considering evidence-based practices and patient-specific factors

• Explain the biomechanics of the ankle and foot.
• Administer thorough examination of the ankle and foot.
• Differentially diagnose the pathological conditions of the ankle and foot.
• Perform soft tissue treatments for the ankle and foot.
• Apply functional relationships of the ankle and foot to associated regions for thorough evaluation and treatment.

• Explain the biomechanics of the ankle and foot.
• Administer thorough examination of the ankle and foot.
• Differentially diagnose the pathological conditions of the ankle and foot.
• Perform soft tissue treatments for the ankle and foot.
• Apply functional relationships of the ankle and foot to associated regions for thorough evaluation and treatment.

• Compare headache criteria and classifications from the World Health Organization, International Headache Society and Cleveland Clinic for chronic, acute and traumatic headaches. 
• Explain primary and secondary headaches for patient comprehension and communication of their condition with other healthcare practitioners. 
• Devise appropriate history, examination and treatment protocols for your adult and child headache patient.
• Utilize Headache categories and criteria to accurately diagnose your patient’s condition for migraines, cluster headaches, tension headaches, medication induced headaches, traumatic headaches and more. 
• Determine headache sequela that may be emergencies for adult and youth headache sufferers.

• Explain the biomechanics of the shoulder
• Describe the examination of the shoulder
• Describe the pathological conditions of the shoulder
• Demonstrate soft tissue treatments for pathological conditions of the shoulder
• Define functional relationships of the shoulder with associated regions 

• Interpret cranial bone, suture and meninges anatomy applicable to the practice of Craniopathy treatment.
• Relate the principles of Craniopathy and cranial faults to their effect on the brain regarding headaches and other conditions.
• Assess the temporomandibular joint, cranial faults and the cervical spine as they interrelate for effective headache treatment protocols.
• Examine cranial bones and sutures using Applied Kinesiology.
• Apply treatment protocols using Craniopathy for cranial bones and sutures, and manipulative therapeutics and manual methods for treating the TMJ and cervical spine.

• Discuss the immediate effect of different sitting postures during a standardized computer task on perceived pain in healthy participants 
• Analyze the immediate and short-term effects of three common sitting postures (slouched, upright and supported sitting with a backrest) on pain, lumbar range of motion, proprioception and trunk muscle activity in asymptomatic subjects
• Summarize the evidence regarding the association between objectively measured sitting time and immediate increases in perceived low back pain 
• Compare the effectiveness of the Smart Work and Life (SWAL) intervention, with and without a height adjustable desk, on daily sitting time during and outside of work

• Determine spinal cord, nerve root and nerve root injuries of the upper extremity.
• Diagnose nerve impingement along the median, musculocutaneous, radial, ulnar, axillary, long thoracic, spinal accessory, suprascapular and greater occipital nerves.
• Detect Pronator Syndrome, Anterior Interosseous Syndrome, Carpal Tunnel Syndrome, Radial Tunnel Syndrome, Posterior Interosseous Nerve Syndrome, Distal Posterior Interosseous Nerve Syndrome and Guyon’s Tunnel Syndrome.
• Apply Manual Methods for treatment of upper extremity nerve compression/elongation and associated syndromes.
• Apply Modalities for treatment of upper extremity nerve compression/elongation and associated syndromes.

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

• This contains all courses with the educational objectives listed from Management of Common Conditions 269 through Management of Common Conditions 271

Hour 1

• Describe the relevance of clinical history as it relates to chronic stress and trauma.
• Recognize signs and symptoms of sympatheticotonia.
• Recognize signs and symptoms of possible CTE.
• Determine appropriate individualized examination procedures based on history answers.

Hour 2

• Refer for diagnosis and advanced testing for CTE.
• Describe layered components of restrictions including updated osseous, muscular, and fascial relational anatomy.
• Describe how to palpate muscle tension versus fascial adhesion versus fascial tension lines.
• Differentiate between osseous restriction, muscular tension, and fascial restriction as they relate to spinal motion restriction.
• Use palpatory findings to select technique application for adjustments that last longer by addressing mechanical root cause and encourage parasympathetic dominance at rest.

Hour 3

• Describe the difference between static misalignments and dynamic spinal restrictions (joints incapable of full range of motion).
• Differentiate with palpation both static and dynamic spinal restrictions.
• Describe neurological information gathered from palpation
• Palpate the patient with chronic pain, trauma history, and/or sympatheticotonia without triggering sympathetic bracing.

Hour 4

• Describe the Oxford Grading Scale for manual muscle testing.
• Describe interpretation of manual muscle testing findings, including differentials for clinical significance of findings other than normal.
• Demonstrate manual muscle testing of major postural muscles.
• Apply manual muscle testing as pre- and post-clinical intervention measures during adjustment visits and to track change during review examination.

Hour 1

• List the relevant indications to assess for imbalance in cross-crawl patterning.
• Describe testing procedures to determine specific cross-crawl pattern imbalances.
• Describe testing procedures to assess for signs of dysautonomia.
• Assess patients for cranial and spinal nerve involvement and refer as appropriate

Hour 2

• Perform seated functional range of motion testing with segmental and curve analysis.
• Perform standing functional range of motion testing with segmental and curve analysis.
• Describe considerations that required modification to common orthopedic tests
• List the orthopedic exam procedures specifically relevant to Fascial Kinetic Chain tension.

Hour 3

• Describe clinical considerations in terms of safety of providing care (knowing when to adjust and when NOT to adjust).
• Define what is “primary” (including considerations of “cause” as well as “least stressful point of access” to determine what to adjust or otherwise apply therapeutic input).
• Recognize patterns of and describe gestalt clinical interpretation for different conditions
• Describe patterns of peripheral nerve interference found through synthesis of clinical history and exam procedures.

Hour 4

• Summarize the concept of an initial Therapeutic Trial of care, including reasoning behind it and how to complete this extension of initial assessment in order to customize patient care.
• Describe considerations for technique selection (including where to start, how intensely to adjust, and how to adjust).
• Explain reasoning behind initial frequency of care, and how/when/why to modify this frequency.
• Describe the considerations for projecting response to care and prognosis.
• Summarize guidelines for patient home care recommendations, including considerations for movement and rest, ergonomics, nutrition, and referrals when appropriate.

• Describe pertinent differential diagnoses for facial pain 
• Breakdown the available interventions available for chronic pain secondary to temporomandibular disorders 
• Compare the effectiveness of two types of treatment – dry needling and upper cervical spinal manipulation versus interocclusal splint therapy, topical NSAIDs and TMJ mobilization for patients with temporomandibular disorder 
• Evaluate the comparative effectiveness of cervical versus combined cervico-craniomandibular manual therapy in patients with temporomandibular disorders (TMD)

• Develop a better understanding of the clinical course of low back pain across different pain durations and populations 
• Assess the literature linking hip biomechanics to low back pain 
• Outline prolonged standing pain developer characteristics and risk factors associated with standing-induced low back pain 
• Investigate the clinical and cost effectiveness of an individualized, progressive walking and education program for preventing recurrences of low back pain 
• Examine the effects of diagnostic labels for low back pain on patients’ perceived need for imaging and other aspects of their condition