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Home › Physical Examination CE Courses › Physical Examination 203: Lumbar Spine and Lower Extremity
At a Glance
| Course: | Physical Examination 203: Lumbar Spine and Lower Extremity · 2 CE hours · $40 |
| Faculty: | Dennis O'Hara, DC, DACBSP |
| Format: | Online, on-demand — start immediately |
| Pricing: | $40 ($20/hr) · automatic bundle discounts |
| Approval: | PACE Provider #34015544 · TCC co-sponsored |
PACE Provider #34015544 · Co-sponsored by Texas Chiropractic College · Completions reported to CE Broker
Low back pain in a young athlete is a pars stress fracture until the imaging says otherwise, and a hip labral tear can evade diagnosis for two years — the lumbar and lower-extremity examination is where a chiropractor earns the diagnosis. Physical Examination 203 is the two-hour course that works the region from the lumbar spine through the hip to the hamstring: the biomechanical screen of the young athlete (foot type, Q angle, weight-bearing radiographs); spondylolysis staged from pars stress fracture to terminal defect, with the STIR-sequence bone marrow edema that marks a pending spondylolysis or an active spondylolisthesis; the lumbar evaluation — mechanism of injury, neurological examination, the diagnostic-testing sequence, disc herniation on MRI, and Milgram's, Ely's, Nachlas, Yeoman's and Kemp's tests; then the hip and thigh, test by test and image by image.
Dennis O'Hara, DC, DACBSP — former team chiropractor for D.C. United and MMA ringside physician — teaches it the way a sports physician examines: anatomy and alignment first (hip range-of-motion norms, femoral torsion, coxa vara and valga), then the conditions of the young and active hip — slipped capital femoral epiphysis, greater trochanteric pain syndrome, gluteal strains and the Trendelenburg test, femoroacetabular impingement and labral tears with the impingement, scour, anvil and foveal distraction tests — then IT band syndrome and Ober's test, and hamstring injuries graded I to III with their mechanisms, testing, MRI and diagnostic ultrasound. It is the companion to his Physical Examination 202 on the neck and upper extremities, and the third course in the CCEDseminars Physical Examination series.
Where This Course Fits — The Physical Examination Series
The CCEDseminars Physical Examination series is the on-demand catalog for the examination skills a chiropractor uses every day. New titles are released as faculty complete them, and there is no bundle in this category: each course is taken on its own, and the multi-course discount applies automatically in the cart when the hours add up.
Neurological Examination
Physical Examination 201: Current Concepts in Pupillometry (Michael Hall, DC, FIACN · 2 CE · $40)
Regional Orthopedic Examination — you are here
Physical Examination 202: Neck and Upper Extremities (Dennis O'Hara, DC, DACBSP · 2 CE · $40)
Physical Examination 203: Lumbar Spine and Lower Extremity — this course (Dennis O'Hara, DC, DACBSP · 2 CE · $40)
The current series, with pricing, lives on the Physical Examination category page.
What You'll Learn
On completing Physical Examination 203 you will be able to:
- Apply a biomechanical screen of the young athlete — standing foot analysis (navicular drop, pes planus, calcaneal torsion, forefoot supination), Q angle, and weight-bearing lumbopelvic and cervical radiographs — alongside care of the acute injury, so the cause of the injury is addressed on re-examination
- Stage spondylolysis from pars stress fracture through active, progressive and terminal defect, select imaging by stage (bone scintigraphy, MRI, CT, oblique films), recognize pending spondylolysis and active spondylolisthesis by bone marrow edema on STIR sequences, and manage with activity restriction and bracing
- Perform the lumbar evaluation: history and mechanism of injury, neurological examination, hyperextension versus hyperflexion injury patterns, the diagnostic-testing sequence from plain films to MRI, lumbar disc herniation on sagittal and axial MRI, Milgram's, Ely's, Nachlas, Yeoman's and Kemp's tests, and facet joint referral patterns
- Examine the hip from anatomy, range-of-motion norms and alignment (femoral torsion, coxa vara and valga, teardrop distance) through slipped capital femoral epiphysis, greater trochanteric pain syndrome, gluteal strains and the Trendelenburg test, femoroacetabular impingement (CAM, pincer and mixed) and acetabular labral tears, using the impingement, scour, anvil and foveal distraction tests and MRI, diagnostic ultrasound and MR arthrography
- Evaluate IT band syndrome with Ober's test, and grade hamstring injuries I to III by mechanism (biceps femoris long head in high-speed running, semimembranosus in extreme hip flexion), supine and prone testing, MRI and diagnostic ultrasound
Course Outline
- The Young Athlete and the Structural Fingerprint Exam — the CPOYA program (Dr. Tim Maggs), Maggs' law of tissue tolerance, the closed kinetic chain; standing foot analysis (navicular drop, pes planus, calcaneal torsion, forefoot supination), Q angle of the knees, weight-bearing AP lumbopelvic, lateral lumbar and cervical radiographs; acute injuries — treat, re-evaluate, then switch to the functional and biomechanical analysis; cold laser, nutritional support and kinesiotaping
- Spondylolysis and Spondylolisthesis — the four distinctions (pars stress fracture, active, progressive, terminal) with imaging and treatment by stage; pending spondylolysis on T1 sagittal STIR (bone marrow edema at the pars) and the Boston overlap brace; axial MRI of bilateral spondylolysis; the adolescent athlete evidence (rest, bracing, stabilization exercise, surgical referral after six months); is the spondylolisthesis active? — MR with STIR sagittal images
- Lumbar Evaluation and Disc Herniation — history and mechanism, neurological evaluation for motor and sensory deficit, hyperextension (posterior arch, facets, pars) versus hyperflexion (disc, neuritis/neuralgia) injuries; diagnostic testing — AP, lateral and oblique films when neurologic signs are absent, MRI for persistent hyperextension pain with negative films or any radicular signs, CT and bone scan less sensitive than MRI; lumbar disc herniation (posterolateral because of the PLL; sagittal and axial T1/T2 MRI); Milgram's, Ely's, Nachlas, Yeoman's and Kemp's tests; facet joint neuroanatomy (medial branch of the dorsal ramus) and sclerotomal referral patterns
- Hip Anatomy and Alignment — ligaments of the hip; posterior and deep posterior muscles with their nerve supply (superior and inferior gluteal nerves, nerve to quadratus femoris, nerve to obturator internus); hip flexors; the acetabular labrum and transverse acetabular ligament; normal hip range of motion; femoral torsion (anteversion above 20°, retroversion below 10°); coxa vara and coxa valga; teardrop distance and avascular necrosis
- Hip Conditions of the Young and Active — slipped capital femoral epiphysis (Salter-Harris type I; risk factors and clinical features); greater trochanteric pain syndrome (causes, point tenderness, resisted abduction, Patrick FABER, lateral thigh radiation, aggravating positions, the 20–35% overlap with lumbopelvic pain); gluteal strains, the Trendelenburg test (73% sensitive, 77% specific) and gluteus medius testing
- Femoroacetabular Impingement and Labral Tears — CAM, pincer and mixed FAI (who gets which, what each damages), the impingement test, MRI findings; acetabular labral tears — presentation, prevalence in athletes with groin and mechanical hip pain, differential diagnosis; scour, anvil and foveal distraction tests (and when long-axis manipulation is contraindicated); MRI, diagnostic ultrasound and MR arthrogram
- IT Band Syndrome — presentation, the muscles attached to the IT band (TFL, gluteus medius and maximus, vastus lateralis), Ober's test
- Hamstring Injuries — grades I, II and III; prevalence, time lost and re-injury rates; mechanisms (biceps femoris long head 6–12 cm from the ischial tuberosity in high-speed running; semimembranosus in extreme hip flexion with its 50-day median healing time); supine and prone hamstring testing; MRI (sagittal, coronal, axial) and diagnostic ultrasound of hamstring tears
Your Physical Examination Faculty
Dennis O'Hara, DC, DACBSP — instructor of this course — is a Diplomate of the American Chiropractic Board of Sports Physicians. A graduate of National University of Health Sciences (BS Human Biology; Doctor of Chiropractic), he served as chiropractor for D.C. United from 1996 to 1998 and as an MMA ringside physician from 2009 to 2015. He teaches the CCEDseminars Sports Injuries, Physical Therapy and Rehabilitation courses and Physical Examination 202: Neck and Upper Extremities, the companion to this course. Faculty profile »
Michael Hall, DC, FIACN — chiropractic neurologist — teaches Physical Examination 201: Current Concepts in Pupillometry. Faculty profile »
Credit, Reporting & State Rules
Physical Examination 203 is a 2-hour on-demand course. Your completion is recorded electronically when you pass the post-course assessment, and your certificate is issued immediately. Completions are reported to CE Broker for the states CCEDseminars serves.
Boards set their own caps on online hours, and some limit hours by category. Before you plan a block of online hours, confirm your board's current rules on the State/Region CEU Approvals page. Texas licensees can verify provider status through the Texas Board of Chiropractic Examiners.
Approved states for this course are listed at the bottom of this page.
What It Costs — and How to Pay Less
Physical Examination 203 is $40 for 2 CE hours — $20 per hour. Multi-course discounts apply automatically in the cart — 10% on 6–9 hours and 20% on 10 or more — with no promo code to enter.
There is no bundle in the Physical Examination category. 203 is the companion to Dr. O'Hara's 202 Neck and Upper Extremities (2 CE · $40) — the two together cover the orthopedic examination from the cervical spine to the hamstring for $80 — and adding Dr. Hall's 201 Current Concepts in Pupillometry (2 CE · $40) makes 6 CE hours, which is where the automatic 10% discount starts: $108 instead of $120, with hours combining across any CCEDseminars category in the same cart.
References
- Lumbar spondylolysis in the adolescent athlete. Phys Ther Sport. 2016;20:56–60. doi:10.1016/j.ptsp.2016.04.003
- Approach to the pediatric athlete with back pain: more than just the pars. Phys Sportsmed. 2015;43(4):421–431. doi:10.1080/00913847.2015.1093668
- Treatment and imaging for varying stages of pars stress fractures and spondylolysis. JNMS: Journal of the Neuromusculoskeletal System. 2002;10(2). American Chiropractic Association.
- Lumbar neural arch (spondylolysis MRI). Radsource.us.
- Femoroacetabular impingement (MRI). Radsource.us.
- Hamstring tears (MRI). Radsource.us.
- Location of hamstring injuries. J Belg Soc Radiol. doi:10.5334/jbsr.2617
- Diagnostic ultrasound of proximal hamstring tears. J Ultrasound Med. doi:10.1002/jum.14804
- Maggs T. The CPOYA program and the Structural Fingerprint® Exam (slides used with permission). cpoya.com.
Frequently Asked Questions
What does Physical Examination 203 cover?
The physical examination of the lumbar spine, hip and thigh as a chiropractor performs it: the biomechanical screen of the young athlete (foot type, Q angle, weight-bearing radiographs); spondylolysis staged from pars stress fracture to terminal defect, pending spondylolysis and active spondylolisthesis on STIR MRI, and bracing; the lumbar evaluation — mechanism, neurological examination, when to order plain films versus MRI, lumbar disc herniation, Milgram's, Ely's, Nachlas, Yeoman's and Kemp's tests, facet joint referral; hip anatomy, range of motion and alignment; slipped capital femoral epiphysis, greater trochanteric pain syndrome (trochanteric bursitis), gluteal strains and the Trendelenburg test; femoroacetabular impingement and labral tears with the impingement, scour, anvil and foveal distraction tests and their imaging; IT band syndrome and Ober's test; and hamstring injuries graded I to III with testing, MRI and diagnostic ultrasound.
Who teaches the course, and who is it for?
Dennis O'Hara, DC, DACBSP — Diplomate of the American Chiropractic Board of Sports Physicians, former chiropractor for D.C. United and MMA ringside physician — teaches the 2-hour course. It is written for Doctors of Chiropractic who examine low back, hip and thigh complaints in practice, especially in young and active patients, and want a sports-medicine examiner's sequence: the injury to rule out first, the tests that confirm, and the imaging that settles it.
How does a chiropractor tell whether a young athlete's low back pain is a stress fracture of the spine?
By the mechanism and the imaging sequence the course teaches. Repeated hyperextension and rotation load the pars interarticularis; if the neurological examination is clean, AP, lateral and oblique films come first, and if pain with hyperextension persists with negative films, MRI follows — a STIR sequence showing bone marrow edema at the pars is a pending spondylolysis that calls for stopping sport and bracing for three to four months. The same STIR images answer whether an existing spondylolisthesis is active: no marrow edema, and the pain is coming from somewhere else.
How is the course delivered, and how do I earn the CE credit?
Physical Examination 203 is online and on-demand: you start immediately after checkout and work at your own pace. When you pass the post-course assessment your completion is recorded electronically and your certificate is issued right away. CCEDseminars is PACE Provider #34015544 and the course is co-sponsored by Texas Chiropractic College; completions are reported to CE Broker for the states served. Approved states are listed at the bottom of this page, and confirming your own board's requirements remains your responsibility.
What pairs well with Physical Examination 203?
Dr. O'Hara's Physical Examination 202: Neck and Upper Extremities is the companion course — the two together cover the orthopedic examination from the cervical spine to the hamstring, 4 CE hours for $80. Add Dr. Hall's Physical Examination 201: Current Concepts in Pupillometry and the three reach 6 CE hours, where the automatic 10% multi-course discount starts ($108 instead of $120). New Physical Examination titles are released as faculty complete them; the current list with pricing lives on the category page.
State approval and licensing reminder. CCEDseminars is PACE Provider #34015544. Approved states for this course are listed at the bottom of this page, and board rules on online hours change — confirming your own board's current requirements before you enroll is your responsibility.
Physical Examination 203: Lumbar Spine and Lower Extremity
2 CE hours · $40 · online, on demand · Dennis O'Hara, DC, DACBSP
CCEDseminars · PACE Provider #34015544 · Reviewed by Monte Horne, DC · Last updated October 22, 2026 (CT)