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Chiropractic Technique Online Course

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Chiropractic Technique Online Course Back To Chiropractic CE Seminars Chiropractic Technique ~ 4 Hours Welcome to Back To Chiropractic Online CE exams: This course counts toward your California Board of Chiropractic Examiners CE. (also accepted in other states, check our website or with your Chiropractic State Board) The California Board requires that you complete all of your CE hours BEFORE the end of your Birthday month. We recommend that you send your chiropractic license renewal form and fee in early to avoid any issues. COPYRIGHT WARNING The copyright law of the United States (Title 17, United States Code) governs the making of photocopies or other reproductions of copyrighted material. Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction. One of these specified conditions is that the photocopy or reproduction is not to be "used for any purpose other than private study, scholarship, or research." If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of "fair use," that user may be liable for copyright infringement. This site reserves the right to refuse to accept a copying order if, in its judgment, fulfillment of the order would involve violation of the copyright law. Exam Process: Read all instructions before starting! 1. You must register/pay first. If you haven't, please return to: backtochiropractic.net 2. Open a new window or a new internet tab & drag it so it's side-by-side next to this page. 3. On the new window or new tab you just opened, go to: backtochiropractic.net website. 4. Go directly to the Online section. DON'T register again. 5. Click on the Exam for the course you want to take. No passwords needed. 6. Follow the Exam instructions. 7. Upon passing exam (70%), you’ll be able to immediately download your certificate, and it’ll also be emailed to you. If you don’t pass, you must repeat the exam. Please retain the certificate for 5 years. DON’T send it to the state board. If you get audited and lose your records, I’ll have a copy. I’m always a phone call away... 707.972.0047 or email: [email protected] Marcus Strutz, DC Back To Chiropractic CE Seminars 33000 North Highway 1 Ft Bragg CA 95437 Chiropractic Technique Online Course Presented by: Dr. Lauren Ragazzo, D.C. For Back to Chiropractic Dr. Lauren Ragazzo, D.C. Why I became a chiropractor instead of a pediatrician: I had Migraine Headaches for seven years- unresolved with multiple neurologists and medications; a doctor of chiropractic resolved this for me in three months. • I worked as the Patient Care Coordinator for the University of Utah Hospital. • I then obtained my Associate of science degree from Salt Lake Community College, as a part of their pre- med track • I then attended Life University, where I completed my Bachelor's of Science Degree in Biology. • I was quickly accepted into the nationally ranked Life University College of Chiropractic in Atlanta, where I then received my Doctor of Chiropractic Degree four years later. • I did my internship with Dr. Jessica Gold in Encinitas California, where I began to work with UFC and MMA fighters, in addition to family practice for wellness care. • I began the chiropractic department for several FQHC facilities which include: Neighborhood Healthcare, the San Marcos chiro branch for North County Health Services, and Family Health Centers of San Diego. My focus in private practice: • Postural correction via: gravity based traction • Wellness care • Treating the injuries of professional athletes How might my experience differ, by working in a FQHC? • I’m working with the underserved communities, therefore: I typically see patients who have not had consistent health care. • I am often their first doctor of chiropractic • I typically see extreme cases every day in practice which include: severe disc herniation, failed surgeries, a history of severe physical trauma, multiple co-morbidities, dependent on pain medication and injections, patients who should be sent to the E.R. for their current condition This course will utilize the following format: • We’re going to look at specific case studies: – Patient history – Examination – Imaging – Diagnosis • All of this information will be integrated: – So that the information we’re learning has real world application – We can connect the technique with the history, imaging an exam findings…. – (As opposed to individual subjects) Case #1 • A 49 year old male returns to your office for a follow up appointment, after receiving one chiropractic adjustment • During the initial appointment his chief complaint was: lower back pain – Which was a 7/10 pain scale – Site L3-S1 I was fortunate enough to have imaging on file for this patient: • 1)thoracic x-ray: s-shaped scoliosis (thoracic dextro, lumbar levo) 2) lumbar x-ray: L4 anterolisthesis 3) lumbar mri: six lumbar vertebrae: L1: disc bulge, L2: disc bulge contacting the thecal sac, L3 disc bulge at thecal sac, L5 anterolisthesis, L6-S1 disc bulge What was the diagnosis for this patient so far based on the imaging? • DX: lumbar disc displacement, • lumbar djd • anterolisthesis of the lumbar vertebrae • six lumbar vertebrae • dextroscoliosis of thoracic spine • levoscoliosis of the lumbar spine *Break down the imaging into the spinal levels we are avoiding first. *Then notate levels that may be treated with gentle chiropractic care (activator typically) • Which spinal levels should we avoid? • The vertebrae are subluxated anterior – Adjusting them P-A would make them worse • It may be hard to isolate the other vertebrae in side posture, with a scoliosis curvature • This patient has multiple levels of herniated discs! • Side posture/ diversified may irritate a disc bulge or make it worse if we’re using a shearing motion to adjust What else stood out about his imaging reports? *He has six lumbar vertebrae! – What a weirdo – You should always palpate and count your spinal levels before adjusting (be specific!) *What else might be important? -He has two disc bulges which are touching the thecal sac! -Which levels were those? L2-L3 @ the thecal sac • What does that mean again? – The disc is touching the outer covering of the spinal cord – That’s bad. – We should probably be careful here What would this condition look like on an MRI? (not the MRI of this case study) How would we adjust this patient? • (note: I can only see these patients 2x per month as per medi-cal) • Adjustment: thoracic spine: gentle diversified/drop • Lumbar spine: low force activator device with the avoidance of L4-L5 (anterolisthesis) • Supine SOT blocks at L6 What was the outcome? • Outcome: lbp decreased from 7/10 to intermittent 4/10 within one adjustment Case #2 • 53 year old male, with chronic lower back pain thirty years in duration • Has a history of multiple gunshot wounds (Injury occurred approximately Thirty years ago) His Lumbar radiology report: • FINDINGS: • BONES: Normal. No significant spondylosis, scoliosis, fracture, or visible bony lesion. • DISC SPACES: There is moderate degenerative disc disease at the L4-5 level. Mild degenerative disc disease at the L1-2, L2-3, L3-4 and L5-S1 levels. • PARASPINOUS: There are two bullets within the central posterior tissues and the right paramedian posterior tissues. • OTHER: There appears to be a small bullet fragment within the left side of the sacral canal. • CONCLUSION: • Small bullet fragment within left side of the sacral canal. Bullet fragments within the posterior soft tissues. Moderate degenerative changes Initial adjustment approach • The patient was laying PRONE • With SOT blocks under the superior pelvis bilaterally (to increase disc spaces) • The Activator device was utilized to adjust all lumbar subluxations • The sacrum was avoided How did the patient respond? • He didn’t. • No change for three visits (did I mention that I only get six visits with a referral?) • So I looked at his x-rays myself to see if I could do more What did I notice? • The bullet fragments were very far from the spine itself and they were adjacent to T10 and T12 (I documented this on every visit so I was aware) • The Sacral bullet fragment was not in the sacral canal. It was lodged in the left sacral base and was not in an area where nerves would be compromised In case you were wondering… • I’ve treated a lot of patients who have been shot • The first patient was a surprise • Five patients later, my eyes don’t get as big during the patient history So how did I change this patients care? • The drop table was utilized for three visits. • The thoracic and lumbar spine were adjusted as well as the sacrum • With the activator utilized for: T10 and T12 when necessary How did the patient respond? • He was feeling much better! • Pain reduced from 7/10 to 0/10, after 30 years of chronic pain However, he had a two month lapse in care after this • Following a 2 month lapse in care, pain had returned to 7/10 • He needed to remain on a wellness are program • Patient education regarding maintenance is very important • He is currently feeling well again, and I see him every two weeks! Anatomical review of: the lumbar spine, pelvis and sacrum Assessment Protocol: Radiographic and Manual Examination Procedures • BP or Base Posterior sacrum: – The definitive assessment for a posterior sacral base or posterior sacral apex is based on a lateral lumbopelvic or sacral spot-shot radiograph. On X-ray, a posterior sacral base is indicated by the following on the lateral view: 1) A decrease in the sacral base angle to less than 36 degrees; 2) Hypolordosis of the lumbar spine; 3) Posteriority of the sacral base George‘s line relative to L5; 4) A posterior open wedge at the L5-S1 disc space.1-2 Text provided by Dynamic Chiropractic Physical examination assessment of BP Sacrum: • Motion palpation may reveal extension fixation at L5-S1.2 Patients with a base posterior sacrum usually can stand erect with no significant forward antalgia, but they may demonstrate a positive Minor's sign when rising from a seated position.
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