(VERY IMPORTANT!)
YOU MUST Read the instructions noted below Before starting your class.
- When you desire to Start your class, simply click the “Begin Session” button. The session will start and the countdown timer will be initiated.
- The Server “Times Out” Every 30 Minutes!
- To ensure you get credit for all your “Logged Time”, you Must click the “Log Time” button at the Top of the “Unit Study Page” every 20-25 minutes. (VERY IMPORTANT!)
- If you fail to click the “Log Time” button every 20-25 minutes, even though the countdown timer continues, the server will “Timeout” and you will lose your session time back to the last time you clicked the “Log Time” button.
- When you desire to Stop your class, simply click the “End Session” button. The session will update itself and you will be able to close the program without losing any of the “Log Time” you have gained to that point.
- When you desire to Continue, simply log into “My Account,” then click on “My Online Classes” from the “My Account” tab on the top menu, and then click the “View Unit” for the class you desire to study. From there simply click the “Begin Session” button and once again the countdown timer will be initiated. (Remember to log time every 20-25 minutes)
- Once you have completed all the required time for the class you will be able to take the quiz. Simply click on the “My Account” button on the top menu, and click on “My Online Classes” and click the “Take Quiz” button to view and take the quiz.
- The Quiz on the bottom of the Unit Study Page is the actual quiz you will take at the end of the class, so it may be helpful to answer the questions as you go. If you fail the test, you will have to contact us to retake the class and the test again.
- It will be helpful to print out a copy of the class with the quiz to study.
(Simply right click with your mouse anywhere on this page and then select “print” from the menu that comes up) - Once you have taken the quiz and passed it your certificate will be available, you can click on the link to your “Certificate.” You can view your certificate by clicking on “My Account” button on the top menu, then go to “My Quizzes” to see the link for your certificate. To Print the certificate, you first open the certificate and then right-click your mouse and select print from the menu. (Side note: it is your responsibility to send a copy of your certificate to the board of chiropractic in your state. We do not send a copy of the certificate to your board. Further, it is also your responsibility to make sure that the online class you take is approved for each state that you desire to get credit in.)
This 12 hour course on Flexibility and Spinal Exercise will include the
following specific topics ;
1. General Overview [ 1 hour ]
2. A Review of the Basic Anatomy of Skeletal Muscles
[ 1 hour ]
3. A Review of the Basic Spinal Structures [ 1 hour ]
4. Clinical Case Management for the Flexibility and Spinal
Exercise Class Patients [ 1 hour ]
5. ICDM Coding for a Flexibility and Spinal Exercise Class
[ 1 hour ]
6. Who, When, Why, and How to Stretch [ 1 hour ]
7. Three types of Stretching: Ballistic, PNF, and Static
[ 1 hour ]
8. Specifics on Spinal Flexibility [ 1 hour ]
9. Spinal Exercise Training [ 2 hour ]
10. Aerobic Exercise in the Spinal Exercise Class [ 2 hour ]
11. Conclusion
OVERVIEW:
The goal of this class, is to give the practitioner another tool to utilize in the clinical case management of his/her patients. The spinal flexibility class and spinal exercise class are tools, which is administered correctly, will not only add depth to the patient’s treatment plan, but will provide the physician with a profitable, time efficient way to add flexibility and spinal exercise to the patient’s treatment plan.
This class will be set up to provide the practitioner with a simple, comprehensive, step-by-step method by which he or she can set up an inoffice, flexibility and spinal exercise class. These classes will make implementation of both a flexibility and spinal exercise program easy for you and your office on Monday morning, or whatever the next day is after you take this class.
The class is set up to give you a thorough working knowledge of a flexibility and spinal exercise class. It will give the practitioner the tools and how to use the proper procedure codes, determine the relative value units of this type of care so you can establish an appropriate fee-forservice, assist you as the physician to develop the case management protocols to determine the clinical necessity for the patient. Give you some parameters to determine if and when the patient is ready for the class, give the basics on how to prepare your patients for a class, give the practitioner a general look at forms that may be needed for a class of this nature, prepare you and your staff for the adding of both a flexibility and spinal exercise class to your schedule in a time efficient way, and answer as many of the various questions you may have two assist you in this process.
Flexibility and Spinal exercise rehab is an integral part of the patient’s treatment protocol. Many of the various spinal problems that occur in the patient’s case are dramatically impacted when adequate spinal muscle strength, power, and endurance are not present. If lack of flexibility, dynamic joint instability, or incorrect biomechanics and poor muscle control were important factors in the etiology of the injury, and we do not address these through spinal exercise and flexibility rehab in their treatment plan, we limit their ability to heal, and very often will add to their length of time it takes to heal. On the flip side, your patients will experience a tremendous decrease of their symptoms when adequate flexibility and spinal muscle strength is present.
Very often in the busy chiropractic practice, it is difficult to address flexibility and spinal exercise rehab on a one-on-one basis, so a spinal flexibility and spinal exercise rehab class offers viable options to meet your patient’s needs and yet not take away from your precious time as a physician. You’ll also have a spinal flexibility and spinal exercise rehab video/DVD that can be purchased and resold to your patient’s to assist you in your patient’s compliance with this type of program, or it could go in place of the spinal flexibility or spinal exercise rehab class for those physicians who do not like talking in a public setting.
The time and setting of the class can allow for a relaxed atmosphere that is an attractive way to insure patient compliance with this type of class. I also recommend you either adding something to drink or eat prior to the class so that the patient will not be distracted from the information that you will be giving them. A popular time to perform this class can be at the lunch hour, and with the addition of food can make a positive substitute to their typical routine. It can also serve as a way that the staff and yourself can have a business lunch on the class. Tax write-offs are a welcome thing in whatever appropriate manner we can obtain them.
It will take a certain period of time to properly implement this type of class, and it will be wise to have a laid out timeline to help you prepare
for your first class. You may desire to break up the responsibilities of certain portions of the class to your various staff members, for instance you as the physician will be best suited to plan out the various spinal flexibility procedures and exercises that you desire to teach, while your staff may handle the arrangements for food, copying of various forms, the scheduling of the patients, the preparation of the classroom, an explanation of any fees that are needed to be collected or filed with insurance.
You as the physician will need to make it a habit to prescribe the spinal flexibility and spinal exercise class to those who have need. This is best to be coupled with the objective findings that you have found in the various evaluations that would support such a class, for example, limited range of motion, weakness of various muscle groups, loss of various spinal curves and spinal segment integrity of the spine on radiographs, noted muscle atrophy, and any associated trigger points that may be present. As you form the patient’s initial treatment recommendations or
an update recommendation for the patient, this prescription should be added as the patient shows need and sufficient progress to be able to handle this type of care, but you as the physician need to pay close attention to the objective findings and the progress that the patient is making to help you determine when you should make a prescription for such a class as this. As you become more sensitive to the patient’s ability to handle flexibility and or exercise within a given patient case management plan, then prescribing this will be just an extension of the natural progress in care. As you utilize the spinal flexibility and exercise DVDs, in conjunction with your class or as a stand-alone tool, you will add depth and reinforcement to your spinal flexibility and exercise rehab programs.
The class does require some space, but very often there are places in the community where you may deliver such a class. Wherever you plan to set up the class, you may find it is an opportunity to reach out to the community, and have a spinal flexibility or exercise class for individuals that are not your patients, but are just interested in improving their spinal health. Some attention should be taken with the individuals that are interested in taking such a class, because with any type of flexibility or exercise, you always have a risk of injury for wide range of reasons. If you have adequate space in your practice, it may only require a slight moving around of the furniture for adequate space. Another factor that you will need to consider is the number of patients that you can handle taking through the various spinal flexibility and exercise procedures, and the financial renumeration from this number. In a class such as this, it may be wise to have additional assistance from a certified trainer/s that way, the trainers will be able to fine tune the positioning of the flexibility procedures and exercises while you explain them.
Overall, these type of classes will give you real flexibility and strength, no pun intended, to prepare your patients for spinal flexibility and exercise rehab. It will also create a basis from which your patients may be able to ask of you, the physician any questions, either in the class or in future appointments relevant to spinal flexibility or exercise rehab. You may desire to break down this class into an upper body, cervical/thoracic section and a lower body, lumbar/sacroiliac section. The many options you will have will almost be limitless, and give you better patient management overall.
A Review of the Basic Anatomy of Skeletal Muscles
Muscle structure: [skeletal muscles consist of densely packed groups of elongated cells known as muscle fibers held together by fiberous connective tissue.
Numerous capillaries penetrate the connective tissue to keep muscle supplied with the abundant quantities of oxygen and glucose needed to fuel muscle contraction.” The threadlike cells of the muscle fibers can be up to 1 foot long. Within these muscle fibers you have myofibrils that are thinner fibers, which are made up of both thick and thin contractile myofilaments. The myofilaments in each myofibril are divided transversely by Z bands along the length of the muscle fiber into units called Sarcomeres. It is through these units that neural impulses stimulate contraction. Each thin myofilament consists mainly of actin, a protein, and tropomyosin, another protein that can inhibit contraction. Along each tropomyosin molecule is a complex of three globular protein molecules called troponin. The thick filamentʼs main component is the protein myosin. Myosin molecules look rather like golf clubs, with their long tails and oval — shaped heads.]2
Muscle contraction: [in a relaxed muscle the thick and thin filaments overlap a little. When a muscle contracts, the thick filaments slide farther in between the thin filaments, rather like interlacing fingers, and draw closer to the Z bands. This action shortens both the myofibrils and the entire muscle fiber. The more shortened the muscle fibers are, the greater the contraction in the muscle as a whole.]3
[The interaction of Myosin and Actin Filaments binds strongly with each other in the absence of tropomyosin and troponin, and in combination with the presence of magnesium and ATP both of which are normally abundant in the myofibril, but one of the globular proteins in troponin has a strong affinity for actin, another globular protein of troponin has a strong affinity for tropomyosin, and the third globular protein of troponin has an affinity for calcium ions. If the troponin-tropomyosin complex is added to the actin filament, this binding does not take place. In the presence of large amounts of calcium ions, the inhibitory effect of the troponin-tropomyosin on the actin filaments is itself inhibited as soon as the actin filaments become activated via the calcium ions, it is believed that the heads of the cross bridges [the face of the golf club] from the myosin filaments immediately become attracted to the active sites of the actin filament, and this in some way causes contraction to occur.]4 You may desire to review your past physiology textbooks for a more in depth look at muscle physiology.
chart#1
chart#2&3
“Over 600 muscles make up nearly half of the weight of the human body.”1 Of the 600 muscles, there are quite a few that make up the neck, low back, thoracic, pelvis and leg, some of these include:
In the anterior aspect of the neck-Sternocloidomastoid, Scalenus, Sternohyoid, Omohyoid,and Platysma
In the anterior of the Thoracic / Lumbar spine- Rectus Abdominis, Internal Oblique, and External Oblique
In the anterior of the upper leg- Quadratus Femoris, Vastus Lateralis, Vastus Medialis, Sartorius, Gracilis, Adductor Longus, Adductor Brevis, Pectineus, and Iliopsoas
chart #4
chart #5
In the posterior aspect of the neck- superficially: Trapezius, Splenius Capitus, Semispinalis Capitus, Splenius Cervicus, Rhomboideus Minor, and Romboideus Major
deep: Rectus Capitus, Superior Oblique, Inferior Oblique, and the Levator Scapula
In the posterior of the Thoracic spine- Erector Spinae, Latissimus Dorsi, Spinalis Thoracis, Romboideus Major, Longissimus Thoracis
In the posterior aspect of the low back-Erector Spinae, Latissimus Dorsi, Gluteus Maximus, Gluteus Minimus, Piriformis, Gemellus Superior and Inferior, Internal Obturator, Quadratus Femoris,
chart#6
In the posterior of the upper leg- Biceps Femoris, Iliotibial Band, Semitendonous, Semimembranous, Adductor Magnus, Gracilis, Vastus Lateralis
In the posterior of the lower leg- Gastrocnemius, Soleus, Peroneus Longus, Extensor Digitorum Longus, Achilles Tendon, Popliteus, Peroneus Longus, Peroneus Brevis, Tibialis Posterior, Plantaris, Flexor Digitorum Longus,Flexor Hallucis Longus
For all intensive purposes, we will not be referring to these individually, but we will make reference to them either as groups or as a single muscle that represents the group’s. As we try to convey to our patients it could get very confusing to them if we utilize each individual name for the muscles, for example just try to remember how confusing it was in the anatomy lab in school trying to figure out which muscle was which.