Principles of Chiro 1. The Chiropractic Paradigm

The TRADITIONAL paradigm of chiropractic is that the body is ______________ and a ______________ organism.

Self-regulating and self-healing

___________________ can adversely affect the nervous system's ability to regulate function.

Vertebral subluxation complex

the CENTRAL focus of chiropractic is to ___________ patient health by - correcting, managing, or minimizing vertebral subluxation through chiropractic spinal adjustments.

Optimize

Chiropractic scope is primarily for _____________ conditions

Musculoskeletal

Refer or co-manage? With who?: fracture/dislocation

Refer (urgent) - ER, Orthopedic surgeon

Refer or co-manage? With who?: infection (osteomyelitis, septic arthritis, meningitis, pneumonia, TB)

Refer (urgent) - 1. ED 2. Infectious disease / Internist

Refer or co-manage? With who?: malignancy (suspected or known)

Refer - Oncologist, PCP

Refer or co-manage? With who?: Neurological emergency (cauda equina, progressive weakness, bowel/bladder loss, foot drop)

Refer (emergency), then co-manage once cleared - ED, Neurologist, Neurosurgeon

Refer or co-manage? With who?: vascular emergency (AAA, carotid/vertebral dissection, stroke, DVT/PE)

Refer (emergency) - ER, Vascular surgeon

Refer or co-manage? With who?: severe unremitting pain not responding to conservative care

Refer - Pain management, PCP

Refer or co-manage? With who?: rheumatologic condition (RA, ankylosing spondylitis, psoriatic arthritis, lupus)

Co-manage - Rheumatologist, PCP

Refer or co-manage? With who?: diabetes/endocrine disorder

Co-manage - PCP, Endocrinologist

Refer or co-manage? With who?: hypertension/cardiovascular disease

Co-manage - PCP, Cardiologist

Refer or co-manage? With who?: pregnancy complication (bleeding, preeclampsia, severe abdominal pain)

Refer - OB-GYN

Refer or co-manage? With who?: pediatric red flags (infection, developmental delay, failure to thrive, abuse)

Refer - Pediatrician, ER

Refer or co-manage? With who?: disc herniation with stable radiculopathy

Co-manage - PCP, Neurologist, Physical Therapist

Refer or co-manage? With who?: post-surgical case (joint replacement, spine surgery)

Co-manage - Surgeon, PT, PCP

Refer or co-manage? With who?: chronic pain syndrome (fibromyalgia, CRPS, psychosomatic pain)

Co-manage - PCP, Pain management, Psychologist

Refer or co-manage? With who?: mental health emergency (suicidal ideation, psychosis, mania)

Refer (urgent) - ER, Psychiatrist (Can treat after they are stable)

Refer or co-manage? With who?: osteoporosis with fracture risk

Co-manage - PCP, Endocrinologist

Refer or co-manage? With who?: sports injury needing advanced imaging or surgery

Refer or co-manage - Orthopedic surgeon, Sports medicine

According to the Biopsychosocial model, pain and disability are influenced by what 3 factors?

Biological - tissue load/inflammation

Psychological - fear-avoidance, catastrophizing

Social - Job, support

Key components of a patient history that may indicate difficulty/prevention of proper healing/recovery but are NOT red flags are called ______________.

Yellow flags

What are the components of "PARTS"

Palpation pain/tenderness

Asymmetry

ROM change

Tissue/tone/texture change

Special tests

We must have at least 2 components of PARTS, at least 1 of them being which?

Asymmetry or ROM change

The space just beyond the elastic barrier where the adjustment happens is called the ___________________ space.

Paraphysiological space

Segmental inhibition of pain transmission from a chiropractic adjustment stems from increased input to what receptors?

Mechanoreceptors type 1-3

1. Type I (Ruffini): static position sense, inhibit pain when stretched.

2. Type II (Pacinian): dynamic movement sense.

3. Type III (Golgi-like): monitor tension, reflex inhibition of muscles.

SMT activates descending inhibitory pathways and brainstem components that cause the release of what 3 neurotransmitters?

Endorphins, serotonin, norepinephrine

BEST clinical outcomes occur when SMT is combined with what 3 additional care components?

Exercise therapy

Patient education

Behavioral strategies

The limit of active ROM produced by voluntary movement is the __________ barrier.

Physiologic

The physiologic barrier is determined by __________ and __________.

Muscle tone / flexibility

The end of normal passive ROM is the __________ barrier.

Elastic

The elastic barrier represents resistance from __________.

Ligaments and soft tissues

The joint can move slightly beyond the elastic barrier into the __________.

Paraphysiologic space

The paraphysiologic space is located between the __________ and __________ barriers.

Elastic / anatomic

Adjustments occur within the __________.

Paraphysiologic space

The cavitation ("pop") occurs in the __________.

Paraphysiologic space

Cavitation is caused by release of __________ gas.

Nitrogen

The absolute limit of joint movement is the __________ barrier.

Anatomic

The anatomic barrier is determined by __________.

Bone, joint capsule, and ligaments

Exceeding the anatomic barrier can cause __________.

Sprain, strain, or fracture

Passive ROM ends at the __________ barrier.

Elastic

Active ROM ends at the __________ barrier.

Physiologic

The safest zone for chiropractic adjustments is the __________.

Paraphysiologic space

The "crack" heard during an adjustment is due to __________.

Gas release in synovial fluid

The anatomic barrier should __________ be exceeded.

Never

Movement beyond the elastic barrier but before the anatomic barrier is __________.

Safe (paraphysiologic space)

A patient-controlled movement reaches the __________ barrier.

Physiologic

A practitioner-applied movement reaches the __________ barrier.

Elastic

The facet orientation of the cervical plane is ______ degrees.

45 degrees

The facet orientation of the thoracic plane is ______ degrees.

60

The facet orientation of the lumbar plane is ______ degrees.

90

The facet orientation of the cervical spine is in what plane?

between transverse and frontal

The facet orientation of the thoracic spine is in what plane?

Frontal

The facet orientation of the lumbar spine is in what plane?

Sagittal plane

What does SOAP stand for in a SOAP note?

Subjective

Objective

Assessment

Plan

What soft tissue technique is considered the gold standard for muscular invovlement?

ART - Active Release Techniques aka Pin and Stretch

Respecting a patient's right to make their own healthcare decisions is called __________.

Autonomy

Providing informed consent is an example of __________.

Autonomy

Acting in the patient's best interest is called __________.

Beneficence

Choosing the most beneficial treatment for a patient demonstrates __________.

Beneficence

Avoiding harm to the patient is called __________.

Nonmaleficence

Modifying care due to contraindications demonstrates __________.

Nonmaleficence

Providing equal care without discrimination is called __________.

Justice

Treating all patients fairly regardless of background demonstrates __________.

Justice

Maintaining honesty and trust with patients is called __________.

Fidelity and veracity

Being truthful with a patient about their diagnosis demonstrates __________.

Veracity

Keeping promises and maintaining patient trust demonstrates __________.

Fidelity

Protecting patient information is called __________.

Confidentiality

HIPAA protects __________ information.

Patient health

Patient information can be shared for __________, __________, or __________.

Treatment, payment, legal requirement

Sharing patient information without consent (outside exceptions) violates __________.

Confidentiality

A patient refusing treatment demonstrates the principle of __________.

Autonomy

Recommending the best evidence-based care demonstrates __________.

Beneficence

Avoiding a risky treatment due to patient condition demonstrates __________.

Nonmaleficence

Treating patients equally regardless of socioeconomic status demonstrates __________.

Justice

Maintaining patient privacy under HIPAA demonstrates __________.

Confidentiality

The number of NEW cases of a condition occurring in a population over a set period of time is the _________.

Incidence

The total number of existing cases of a condition in a population at a single moment or over a period is the _______.

Prevalence

The proportion of true positives detected by a test is the _________.

Sensitivity

The proportion of true negatives detected by a test is the __________.

Specificity

A study in which the researcher does not intervene, but only observes what happens naturally

Observational study

- Cohort

- Case-control

- Cross-sectional

A prospective, controlled experiment used to evaluate the efficacy or effectiveness of a treatment.

Clinical Trial

A study that simply describes the events which took place for the treatment of a patient/group along with the results.

Descriptive Study

A study that follows subjects forward in time to see how certain factors affect future outcomes

Prospective study

A study that looks backward in time, often using medical records, to determine exposures that may have contributed to an outcome

Retrospective study

A study that follows a defined group of people over time to see who develops a certain outcome.

Can be prospective or retrospective

Cohort Study

Both the patient AND the clinician/researcher assessing outcomes do not know which treatment the patient received.

Double-Blind Study

A prospective study where subjects are randomly assigned to different treatment groups

Randomized controlled trial

What is the Hierarchy of evidence starting with the TOP going to the bottom

1. Meta-Analysis / Systematic Review

Randomized Controlled Trial

Cohort Study

Case-Control Study

Cross-Sectional Study

Case Series / Case Report

Expert Opinion / Textbooks