Physical Examination 206: Knee and Lower Leg

The conditions of the knee and lower leg a chiropractor examines, from the ankle up: lateral inversion ankle sprains and their grading with the anterior drawer and talar tilt tests; talar dome fractures and their staging; high ankle sprains and the syndesmosis squeeze test; the deltoid ligament, eversion sprains, medial malleolar avulsion and Kleiger's test; the Ottawa Ankle Rules; medial tibial stress syndrome (shin splints) with the navicular drop test and the female athlete triad; posterior tibial tendon dysfunction and tarsal tunnel syndrome; Achilles tendinitis and rupture with the Thompson test, ultrasound and MRI; chronic exertional compartment syndrome; and the knee — effusion, bursae, patellar dislocation, Osgood-Schlatter, the ACL and Lachman test, valgus collapse and Q angle, the PCL and posterior sag sign, meniscal tears with the Thessaly and McMurray tests, collateral ligament grading, and patellofemoral pain syndrome with rehabilitation and taping.

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 see athletes and active patients with knee, shin and ankle complaints and want a repeatable examination for each: the grading scheme, the orthopedic test with its positive finding, the imaging that confirms it, and the point at which the case is referred.

With the Ottawa Ankle Rules first — the course teaches the tenderness zones and weight-bearing criteria that decide whether an ankle x-ray series is needed, from the original emergency-department study that found the rules 100% sensitive while cutting unnecessary films by about a third. Then by watching the sprain that does not behave: persistent pain after an inversion sprain with joint-line tenderness along the ankle mortise points to a talar dome fracture, which the course stages from a subchondral compression that is negative on x-ray (grade I) to a detached, displaced fragment (grade IV) and confirms on MRI, the most sensitive study. On the medial side, the force needed to tear the deltoid ligament can avulse the medial malleolus and fracture the distal fibula, so a grade III eversion sprain is treated as a possible fracture until imaging says otherwise.

Physical Examination 206 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.

Dr. O'Hara's Physical Examination 203: Lumbar Spine and Lower Extremity is the companion course — 203 covers the lumbar spine, hip, IT band and hamstring, 206 the knee, lower leg and ankle, so the two together cover the lower extremity from the lumbar spine to the foot for $80. Add a third Physical Examination course — his 202: Neck and Upper Extremities, Dr. Ozello's 205: Cervical Spine, Dr. Riggs' 204: Cerebral and Vascular Risks or Dr. Hall's 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.