How to use this: open the walkthrough first and go at your own pace with the arrow keys or Next. Then open the Lab: run the simulator, practise in the trainer with its hints and worked solutions, and try the scenarios. Use the tools bar at the top of each page to pause the animations, slow them down, have the text read aloud, or get a written description of each picture. For learning only, not medical advice and not a guide to treatment.
Module 1 The spine in three dimensions
Regions and curves, the parts of a vertebra, the disc, ligaments, the cord and cauda equina, stabilizing muscles, and why imaging findings are common without pain.
- Regions and curves
- Vertebra parts
- Atlas and axis
- Intervertebral disc
- Ligaments
- Motion segment
- Cauda equina
- Sacroiliac joint
- Multifidus
- Imaging findings
Module 2 Spinal biomechanics
Planes and axes, regional motion, coupled motion, stability, torque and lifting math, disc pressure, load sharing, creep and bracing.
- Planes and axes
- Facet orientation
- Coupled motion
- Neutral zone
- Torque and moment arm
- Lifting math
- Disc pressure
- Creep
- Bracing
Module 3 Joints, cavitation and tissue response
Synovial joints and fluid, joint sensors, what the pop really is, collagen under load, healing phases, and loading versus immobilization.
- Synovial fluid
- Mechanoreceptors
- Cavitation
- Refractory period
- Knuckle cracking
- Stress strain curve
- Healing phases
- Wolff's law
- Hypermobility
Module 4 Manipulation and mobilization mechanics
Thrust versus mobilization, force time curves, how precise force really is, proposed mechanisms and their evidence, guidelines, and safety and consent.
- HVLA thrust
- Mobilization grades
- Force time curve
- Specificity
- Proposed mechanisms
- Placebo and context
- Guidelines
- Adverse events
- Informed consent
Module 5 Nerve roots, dermatomes and reflexes
Roots and the spinal nerve, numbering and the foramen, dermatomes, myotomes, reflexes, radicular pain versus myelopathy, and red flags.
- Root numbering
- Intervertebral foramen
- Disc herniation
- Dermatomes
- Myotomes
- Reflex grading
- Radiculopathy
- Myelopathy
- Straight leg raise
Module 6 Pain neuroscience
Nociception versus pain, fiber types, the four processes, sensitization, gate control, brakes from the brain, placebo and nocebo, chronic pain, and the biopsychosocial model.
- Nociceptors
- Fiber types
- Inflammatory soup
- Gate control
- Descending modulation
- Placebo and nocebo
- Central sensitization
- Nociplastic pain
- Biopsychosocial model
- Pain scales
Module 7 Exam logic and red flags
The history, what exam tests load, sensitivity and specificity, predictive values and prevalence, red and yellow flags, imaging, referral and SOAP notes.
- History taking
- Provocation tests
- Sensitivity and specificity
- Predictive values
- Likelihood ratios
- Red flags
- Yellow flags
- Imaging guidance
- Referral
- SOAP notes
Module 8 Posture, gait and movement
Balance and posture, forward head levers, the gait cycle, ground reaction forces, gait speed math, muscle timing, common gait patterns, and exercise.
- Center of mass
- Posture variability
- Forward head posture
- Gait cycle
- Ground reaction force
- Cadence and speed
- Muscle timing
- Antalgic gait
- Foot drop
- Exercise for back pain
Module 9 Chiropractic models through history
The 1800s healing landscape, D.D. and B.J. Palmer, Innate Intelligence, how the subluxation idea changed, straights and mixers, the law, Wilk v. AMA, and what research supports today.
- D.D. Palmer
- B.J. Palmer
- Innate Intelligence
- Subluxation models
- Straights and mixers
- Licensure
- Morikubo
- Wilk v. AMA
- NINCDS 1975
- Evidence today
Module 10 The transformation of American medicine
Competing healers, germ theory, the AMA and licensing, the Flexner Report and who lost, hospitals and insurance, the epidemiologic transition, and integrative care.
- Heroic medicine
- Homeopathy
- Germ theory
- AMA 1847
- Flexner Report
- Insurance and Medicare
- Epidemiologic transition
- Biopsychosocial model
- Complementary vs alternative
- Integrative care
Module 11 Reading the evidence
Why people improve anyway, study designs, fair trials and sham controls, effect sizes, absolute and relative risk, NNT, confidence intervals, forest plots, bias and GRADE.
- Natural history
- Regression to the mean
- Study designs
- Blinding and sham
- MCID
- Effect size
- NNT and NNH
- Confidence intervals
- Forest plots
- GRADE
Module 12 Stress and the autonomic nervous system
Homeostasis and allostatic load, sympathetic and parasympathetic wiring, organ by organ effects, the HPA axis and cortisol, chronic stress, heart rate variability and the evidence on coping.
- Allostatic load
- Sympathetic
- Parasympathetic
- Vagus nerve
- HPA axis
- Cortisol rhythm
- Chronic stress
- Heart rate variability
- Baroreflex
- Appraisal
Module 13 Breathing, meditation and yoga
Breathing mechanics, CO2 and overbreathing, breathing and the heart, meditation and the brain, mindfulness programs and their evidence, yoga, tai chi and safety.
- Diaphragm
- CO2 and pH
- Overbreathing
- Slow breathing
- Respiratory sinus arrhythmia
- Meditation types
- Default mode network
- MBSR
- Yoga
- Tai chi
Module 14 Traditional systems and nature therapy
Traditional Chinese Medicine and acupuncture research, Ayurveda and heavy metal safety, herbal medicine and herb drug interactions, naturopathy, forest bathing, and talking with patients.
- Qi and yin yang
- Five phases
- Acupuncture trials
- Sham needles
- Doshas
- Heavy metals
- St. John's wort
- Herb drug interactions
- Shinrin yoku
- Shared decisions