Hong Kong Chiropractic Continuing Education

Section 1: What is the Biopsychosocial (BPS) Framework?

• Discuss the importance of philosophical frameworks in clinical practice.
• Summarize prominent pain theories throughout history.
• Explain the origin of the biopsychosocial (BPS) model and critique the traditional application of the BPS approach.

Section 2: A Biopsychosocial Framework for Clinicians

• Outline best practices for the care of musculoskeletal pain.
• Breakdown the concepts of patient-centered care, shared decision making and brief action planning.
• Recognize the enactive approach as a modern application of the BPS model, incorporating humanism and empathy to foster a strong therapeutic alliance.
• Integrate evidence-based strategies to facilitate effective self-care strategies for your patients.
• Describe psychologically-informed care as a clinical construct
• Relate BPS framework concepts to your clinical approach for pain

Section 3: Practical Application of a Biopsychosocial/Humanistic Approach

• Fine tune your clinical processes to deliver a great patient experience.
• Leverage evidence-based techniques when receiving a patient’s history.
• Deliver a diagnosis and pain education in a BPS framework.
• Structure a treatment plan in collaboration with your patient.
• Identify strategies to manage pain flare-ups.

Section 4: Course Conclusion

• Summarize practical ways to enhance the use of BPS principles in your practice

• Apply thorough passive and active examination methods to soft tissue structures of the cervical spine, TMJ, thoracic spine and rib cage, lumbopelvic spine, and upper and lower extremities.
• Discern between scleratomal pain, dermatome pain and myofascial pain to assist in examination procedures and treatment outcome.
• Determine necessity for diagnostic imaging of soft tissue structures after acceleration/deceleration impact.
• Explain the best treatment options to your patient after complete examination is combined with their particular accident Movement Dynamics and forces upon the patient’s body at impact.
• Utilize examination findings in combination with Factor Analysis and complicating factors to best determine treatment plan and prognosis.

• Determine the effect of chiropractic on movement time
• Assess the effects of spinal manipulation and ultrasound on chronic low back pain
• Describe heart rate variability as a measurement tool
• Assess the effects of chiropractic on heart rate variability

• Determine the effect of thoracic spine manipulation on autonomic output to the heart
• Review criteria for the diagnosis of cervicogenic headaches
• Describe a clinical assessment for cervicogenic headaches
• Assess the effects of chiropractic and spinal manipulation on cervicogenic headaches

• Describe spinal manipulation use by time, place, and person, identify predictors of the use of spinal manipulation
• Review cost-effectiveness of SMT compared to other treatment options for people with spinal pain of any duration
• Describe the current literature on patient-centered outcomes following a specific type of commonly used SM, high-velocity low-amplitude (HVLA), in patients with LBP
• Review the putative mechanical features of the subluxation and three theories that form the foundation for much of chiropractic practice

• Provide an overview of research on the effects of spinal manipulation on sensory processing, motor output, functional performance and sensorimotor integration
• Examine performance based outcome measures used in an attempt to objectively measure the ramifications of spinal manipulation
• Update knowledge regarding several physical characteristics of an applied SMT, and review what is known about the signaling characteristics of sensory neurons innervating the vertebral column in response to spinal manipulation
• Review the physiological evidence that spinal manipulation can impact visceral function

• Outline the limitations of a recent trial on preventive treatments including spinal manipulation for neck pain and how they contribute to our interpretation of the results of the study
• Interpret results of an important trial on spinal manipulation and exercise for neck pain
• Discuss recent evidence comparing spinal manipulation to mobilization for recent onset neck pain
• Use recent evidence to justify manipulating various spinal regions for patients with neck pain
• Critique the potential for chest and neck mobilizations to affect spirometric performance (breathing)

• Contrast Clinical Guideline-based care with usual medical care for acute low back pain
• Recognize the potential benefit of adding exercise prescription to spinal manipulation for low back pain
• Compare the effectiveness of spinal manipulation to McKenzie Method interventions for persistent low back pain
• Outline factors that may help predict improvement in patients seeking chiropractic care for low back pain
• Explain the benefits of evidence-based care for low back pain

• Compare the efficacy of standard medical care (SMC) alone versus chiropractic spinal manipulation + SMC for acute low back pain patients
• Discuss the value of a combined (pragmatic) chiropractic approach for treating low back pain
• Analyze the state of the research literature directly comparing spinal manipulation, exercise and acupuncture as treatments for low back pain
• Update your understanding of joint cavitation during side posture lumbar manipulation
• Critique the only study (to date) on maintenance care for low back pain including spinal manipulation

• Develop evidence-based chiropractic treatment recommendations for nonspecific (mechanical) neck pain in adults
• Discuss the clinical criteria justifying spinal manipulative therapy for neck pain
• Assess the relative effectiveness of spinal manipulative therapy and rehabilitative exercise for neck pain in seniors
• Describe the working mechanism of manual therapy in participants with chronic tension-type headache
• Examine the cerebrovascular hemodynamic response of cervical spine positions using MRI on the vertebral artery

• Critique the state of the evidence for manual therapy interventions in the treatment of cervical radiculopathy
• Compare two common interventions – spinal manipulation and nerve root injection – for patients with MRI-confirmed lumbar disc herniation
• Critique the state of the evidence for spinal manipulation (specifically) in the treatment of cervical radiculopathy
• Interpret the results of a cohort study of MRI-confirmed symptomatic cervical disc herniation patients treated with cervical manipulation
• Compare isolated cervical SMT versus a combination of cervical, cervico-thoracic and thoracic SMT in patients with chronic mechanical neck pain

• Describe the science behind chiropractic care
• Translate the intent of manipulative therapy to patients and other healthcare providers
• Describe the potential results of not having recommended chiropractic care
• Outline the different theories of the subluxation complex
• Justify the care you recommend based on electrodiagnostic, imaging, and laboratory studies

• This contains all courses with the educational objectives listed from Manipulation 117 through Manipulation 122

• Identify a sub-group of recurrent low back pain patients that might respond most favorably to a maintenance care schedule
• Summarize existing research literature on chiropractic maintenance care
• Investigate short-term changes in pain-pressure threshold (PPT) and temporal summation (TS) after lumbar spinal manipulation (SMT) compared to a credible sham intervention
• Determine whether cervical spinal manipulation leads to meaningful changes in vertebral and cerebral hemodynamics, compared to neutral or end-range neck rotation postures in adults with chronic neck pain
• Summarize the current state of the literature regarding the neurophysiological effects of high-velocity, low-amplitude spinal manipulative therapy (HVLA-SMT) in asymptomatic and symptomatic humans
• Critique the existing, sham-controlled literature evaluating the acute changes in autonomic nervous system (ANS) markers and function in patients receiving manipulation to spinal or peripheral joints

Hour 1

• Identify important spinal anatomy with relation to joint pain, degeneration and stabilization.
• Explain the efficacy of spinal manipulation (SM) for various clinical presentations
• Discuss current literature reviews regarding safety concerns and controversies with SM.
• Perform joint manipulative procedures to the spine and pelvis

 Hour 2

• Discuss common clinical anatomy related to the trunk and torso, with practically to joint manipulation.
• Examine the thoracic and lumbar spine through important clinical landmarks and topical anatomical structures.
• Perform alternative manipulative procedures to the spine and pelvis

 Hour 3

• Discuss common clinical anatomy related to the head, and neck.
• Examine the cervical spine through important clinical landmarks and topical anatomical structures.
• Perform joint manipulative procedures for cervical spine.
• Perform manipulative and mobilization procedures to the temporomandibular joints.

• Examine the effect of chiropractic manipulation on reaction and response time in combat-ready special operations forces qualified personnel
• Assess the influence of chiropractic care on the strength, balance, and/or endurance in active-duty United States military personnel
• Evaluate the impact of upper- vs lower-extremity chiropractic manipulation on postural sway and dual task performance
• Provide an update regarding the mechanisms of action for manual therapy, the impact of manual therapy on pain management, health care conditions for which manual therapy may be beneficial and treatment plans

Hour 1

• Review common foot and ankle anatomy.
• Evaluate the foot and ankle.
• Perform physical and neurological examinations and tests related to the foot and ankle.
• Identify uncomplicated common conditions during the evaluation of the foot and ankle.

 Hour 2

• Discuss evidence-based literature suggesting the practically of manipulation of the foot and ankle.
• Perform adjustments of the foot.
• Perform adjustments of the ankle.
• Utilize a speeder/toggle board for the foot.

 Hour 3

• Describe the impact of disturbances on the determinant factors of health in the structures of the foot and ankle
• Apply corrective and preventative measures to conditions affecting the health of the foot and ankle
• Utilize evidence-based low technology rehabilitative methods to manage patient care of common foot and ankle conditions.
• User strategies to address challenges patients have with adhering to rehabilitative programs.

Hour 1

• Review common hand, wrist and shoulder anatomy.
• Evaluate the hand write and shoulder.
• Perform physical and neurological examinations and tests related to hand wrist and shoulder.
• Identify uncomplicated common conditions during the evaluation of the hand wrist and shoulder

Hour 2

• Discuss evidence-based literature suggesting the practically of manipulation of the hand, wrist and shoulder.
• Perform adjustments of the hand.
• Perform adjustments of the wrist.
• Perform adjustments of the shoulder

Hour 3

• Describe the impact of disturbances on the determinant factors of health in the structures of the hand, wrist and shoulder
• Apply corrective and preventative measures to conditions affecting the health of the hand, wrist and shoulder
• Utilize evidence-based low technology rehabilitative methods to manage patient care of common hand, wrist and shoulder
• User strategies to address challenges patients have with adhering to rehabilitative programs.

• Summarize existing literature regarding the neurophysiological mechanisms of spinal manipulation for spine pain 
• Identify the beliefs, perceptions and practices of chiropractors and patients regarding benign adverse events after spinal manipulation and potential strategies to mitigate them
• Explore recent research pertaining to the importance or segmental pain and stiffness when targeting the application of spinal manipulation
• Assess the literature on the effect of SMT on acute neck pain, including pain, disability and quality of life measures and reported adverse effects
• Examine the evidence pertaining to the efficacy and effectiveness of spinal manipulation for preventing infectious disease and improving disease-specific health outcomes among patients with infectious disease

• Define and classify adverse events associated with manipulation and mobilization
• Review symptoms patients perceive as adverse
• Describe the incidence of severe adverse events among chiropractic recipients
• Outline adverse events in the pregnant and postpartum periods

• Summarize our current understanding of biomechanical and biochemical processes that contribute to the development of discogenic back pain 
• Assess the possible association between receiving chiropractic spinal manipulation and the risk of subsequent cauda equina syndrome (CES) in adults with low back pain 
• Determine the impact of receiving chiropractic spinal manipulation on the odds of being prescribed Benzodiazepines for radicular low back pain 
• Establish if receiving chiropractic spinal manipulation following a radicular low back pain diagnosis influences the likelihood of subsequently receiving a gabapentin prescription 
• Examine the association between receipt of spinal manipulation and tramadol prescription among adults with a new diagnosis of radicular low back pain

History and Background

• Recognize the historical emergence of spinal manipulation (SMT) throughout numerous time periods and among different professions
• Outline the development of the chiropractic profession from the late 1800s to modern day
• Briefly review existing and historical models of spinal manipulative therapy (SMT)

What’s that sound?

• Distinguish cavitation from tribonucleation and explore the relevance of the popping sound with SMT.

 Mechanisms

• Integrate the concept of mechanotransduction into your understanding and appraisal of SMT mechanisms
• Outline different ways methods to provide mechanical stimulation during chiropractic treatment
• Explain what the evidence tells us about joint motion, gapping and location of popping sounds with SMT
• Explore contemporary areas of scientific inquiry into the neurophysiologic mechanism(s) of action for high-velocity spinal manipulation
• Describe how SMT may influence pain modulation
• Critique the evidence relating to the influence of SMT on blood biomarkers and immunity
• Discuss the potential brain and sensorimotor functional impacts of SMT
• Appreciate the relevance of spinal stiffness and the potential impact of SMT on spinal biomechanics
• Summarize existing evidence relating to the SMT and muscle function.

Clinical Considerations

• Describe clinical factors that could influence how SMT exerts its effect(s).
• Discuss existing evidence on the dose-response relationship between SMT and clinical outcomes.
• Recognize the importance of contextual factors, patient expectations and comfort in driving positive clinical outcomes.
• Briefly summarize existing research on studies evaluating SMT for non-spinal conditions.

Course Conclusion

• Propose an integrated, conceptual model of how SMT may exert its effects for our patients.
• Recognize that chiropractic care helps patients via many aspects of the clinical encounter.

• List and define the components of the SINSS classification used for an upper quarter evaluation
• Recall two neurophysiological effects of upper quarter joint mobilizations
• Cite two indications for performing grade 1-2 joint mobilizations to the upper quarter
• Identify two conditions that would warrant performing grad 3-4 joint mobilizations to the upper quarter
• Enumerate 5 contraindications for performing joint mobilizations to the upper quarter State two specific diagnostic or impairment-based indications for performing a cervical distraction mobilization.
• Summarize the purpose for performing a posterior mobilization to the glenohumeral joint
• Paraphrase the clinical prediction rule used to determine the effectiveness of cervico-thoracic mobilizations for patient’s presenting with subacromial impingement.

• List and define the components of the SINSS classification used for a lower quarter evaluation
• Recall two neurophysiological effects of joint mobilizations as applied to the lower quarter
• Cite two indications for performing grade 1-2 joint mobilizations for the lower quarter
• Identify two conditions that would warrant performing grad 3-4 joint mobilizations for the lower quarter
• Enumerate 5 contraindications for performing joint mobilizations as applied to the lower quarter
• State two specific diagnostic or impairment-based indications for performing a lateral to caudal hip joint mobilization.
• Explain the purpose for performing a posterior to anterior proximal tibiofibular glide
• Provide two common indications for performing a medial patella mobilization technique

• Discuss the history behind the discovery of and development of releasing somatic dysfunction via positional release techniques via the work of Lawrence Jones, DO, George Goodheart, DC and others
• Discuss the basic concepts of how the body responds to stress and trauma  according to Irvin Korr and how slackening the dysfunctional muscle and joint tissues works to restore normal function.
• Apply anatomy and kinesiology as a means of finding and unwinding somatic dysfunction.
• Include the learned techniques into your practice.
• Compare and contrast the rapid thrust vs. positional release modes of releasing subluxations or somatic dysfunction. 

• Summarize the muscle spindle, specifically, the anatomy and physiology of the spindle subcomponents and how it regulates function of skeletal muscle.
• Breakdown the neural reflex mechanisms of the muscle spindle and appreciate how these mechanisms operate in both somatic function and dysfunction.
• Explain the hypothesis of the “facilitated segment” aka somatic dysfunction, explained both in terms of neurology and by analogies so as to be clear to both the doctor and the patient
• Identify somatic dysfunction via locating tender points and learn the mechanism of slackening in order to relieve the tender point reactivity and restore normal function to the muscle and joint.
• Identify and correct tender point locations and positional releases.

• 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.

• 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.

• 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.

• Discuss essential MRI sequence behavior (T1, T2, STIR) and standard lumbar MRI protocols to confidently navigate images.
• Identify and interpret normal lumbar anatomy, common variants, and core pathologies (disc pathology using nomenclature, stenosis grading, Modic changes).
• Integrate findings into chiropractic decision-making—including indications/contraindications to manipulation, documentation, and clear referral communication.

• Discuss neuro-musculoskeletal imaging relationships by identifying how brain and extremity MRI findings correlate with neurological, postural, and biomechanical dysfunction.
• Differentiate MRI sequence interpretation for neurologic and orthopedic regions, emphasizing pattern recognition of soft-tissue vs. neural signal changes.
• Recognize early degenerative and inflammatory changes in peripheral joints and associated neural structures using MRI analysis.
• Apply MRI findings to evidence-based chiropractic case management, including safe referral, patient education, and interdisciplinary communication.
• Document MRI utilization ethically and effectively to meet clinical, legal, and CE compliance standards.

• 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.

• Discuss essential MRI sequence behavior (T1, T2, STIR) and standard lumbar MRI protocols to confidently navigate images.
• Identify and interpret normal lumbar anatomy, common variants, and core pathologies (disc pathology using nomenclature, stenosis grading, Modic changes).
• Integrate findings into chiropractic decision-making—including indications/contraindications to manipulation, documentation, and clear referral communication.

• Discuss neuro-musculoskeletal imaging relationships by identifying how brain and extremity MRI findings correlate with neurological, postural, and biomechanical dysfunction.
• Differentiate MRI sequence interpretation for neurologic and orthopedic regions, emphasizing pattern recognition of soft-tissue vs. neural signal changes.
• Recognize early degenerative and inflammatory changes in peripheral joints and associated neural structures using MRI analysis.
• Apply MRI findings to evidence-based chiropractic case management, including safe referral, patient education, and interdisciplinary communication.
• Document MRI utilization ethically and effectively to meet clinical, legal, and CE compliance standards.