Sunday, July 4, 2010

Minimal Educational Requirements

Comparison of the Education of DCs and MDs
Both chiropractic and medical schools require certain course work for admission. These vary from school to school. Very few schools of either type require a bachelor's degree, although some specify that they prefer the applicant have such a degree.
Chiropractic colleges do not require the MCAT. Some medical schools do. Contrary to common belief, some medical schools (including high profile institutions) require the bare minimum of undergraduate requirements.
We took the admission requirements for medical schools from the publication titled: Medical School Admission Requirements, 1997-1998: United States and Canada, 47th edition (published by The Association of American Medical Colleges). Admission requirements for accredited chiropractic schools are dictated by the Council on Chiropractic Colleges (the agency appointed by the U.S. Dept. of Education to accredit chiropractic colleges).
The Parker College study reported that on average, chiropractic college involves 372 more classroom hours than medical school. Chiropractic students also have more hours of training in anatomy, physiology, diagnosis, and orthopedics (the musculoskeletal system).
It should be apparent from looking at the data below that in general, the chiropractic student has a more extensive classroom education and practical training in these areas, particularly in diagnosis, than the medical student.
Requirements for Admission to
Chiropractic and Medical Schools
College Courses
Parker Chiropractic College Harvard Medical School Stanford University
Biological Science (with lab) 1 year 1 year 1 year
General or Inorganic Chemistry 1 year 1 year 1 year
Organic Chemistry (with lab) 1 year 1 year 1 year
Physics (with lab) 1 year 1 year 1 year
English or Communicative Skills 1 year
Psychology 1/2 year
Humanities or Social Sciences 22.5 quarter hours
Electives 6-to-18 quarter hours.
Degree Requirements
These basic educational requirements for graduates of both chiropractic and medical schools show that although each has its own specialties, the hours of classroom instruction are about the same. (The class hours for basic science comparisons were compiled and averaged following a review of curricula of 18 chiropractic colleges and 22 medical schools.)
Minimum Required Hours
Chiropractic College Medical School
456 Anatomy/Embryology. 215
243 Physiology 174
296 Pathology 507
161 Chemistry/Biochemistry 100
145 Microbiology 145
408 Diagnosis 113
149 Neurology 171
56 Psychology/Psychiatry 323
66 Obstetrics & Gynecology 284
271 X-ray 13
168 Orthopedics 2
2,419 Total Hours for Degree 2,047

Friday, July 2, 2010

Radiology #4 Osteoarthritis

As I'm stuck in town for the holiday three day weekend so I can study for my upcoming diagnostic imaging III midterm, I decided to post about a topic that I'm going to be tested over. Let's first start off talking about arthritis. Everyone has seen the tylenol commercials for "joint pain" with the geriatric patients walking around holding their backs, necks, hand, etc anything to make the public sympathetic to a condition that they are already forming. Arthritis is defined as the inflammation of one or more joints which results in pain, stiffness and limited movement. There are over 100 different types of arthritis but today we will be focusing on osteoarthritis (OA) or as it's also known as degenerative joint disease. OA is the most common joint disorder, and it's not surprising because most injury sites, such as the fractures previously blogged about, will eventually turn into OA because they weren't properly rehabbed, patients didn't comply with doctor's orders, or simply from overuse. OA occurs when the cartilage lining the joints wears down, causing more stress on the bones in the joint. It's radiographically found as joint space narrowing with an increase in the cortical margins of the bones also known as subchondral sclerosis. Note the difference between the normal (top) knee radiograph and the one demonstrating OA (bottom). Medical treatment includes pain relievers and physical therapy. Chiropractic treatment includes adjusting to restore motion into the joint that has lost it's motion, physical therapy to rehab the surrounding musculature and ligaments and nutritional counseling, where applicable.

Thursday, July 1, 2010

Case #1 Inversion Ankle Sprain Injury

In an attempt to become more of an educator and less of an informative know-it-all, let me first start off this blog by talking about motion. Every joint in the human body has some sort of motion, whether it's pretending you can fly with your arms or tucking them under your pillow when you sleep. Many health care practitioners, including chiropractors, will, when a joint is injured or as a daily objective test will put a joint through it's entire range of motion. When the patient does this by themselves, it is known as active ranges of motion or AROM. Another test for ranges of motion include the patient relaxing the joint and letting the practitioner take the joint through it's motion, this is called passive ranges of motion or PROM (or as I tell my patients, I'm going to take you to your prom now!). If pain is provoked during PROM, this indicates ligamentous injury. (Ligaments attach bone to bone). The final range of motion testing is called resisted ranges of motion or RROM, where the practitioner will resist the patient as they actively put the joint in question through it's range of motion. If pain is provoked on RROM, the pain is due to muscular injury, as you are utilizing your muscles to resist the motion.

Onto the more interesting item at hand: Did you know that over 25,000 inversion ankle sprains are reported every day? Let me first define inversion ankle sprain. An inversion ankle sprain is when someone rolls their ankle in such a way that the bottom of their foot is facing the opposite foot or inward, compared to an eversion ankle sprain where the bottom of the foot is facing outward, away from the other foot. I currently have a young adult, male patient who came in with an extremely bruised and inflammed (swollen) left ankle. Mechanism of injury: he was playing lacrosse when he rolled his ankle via inversion and while rolling his ankle, he was pushed forward. After doing a thorough ankle regional examination, his PROM provoked pain which added a mark in my intial thought column of ligamentous injury (don't give me too much credit, it's how most inversion sprain injuries come out), orthopedic testing confirmed as well. If you will notice in the picture to the left of a normal ankle, there are three ligaments on the outside or lateral side of the ankle that attach the fibula (one of the lower leg long bones) to the ankle. The most common ligament to be injured is the anterior talofibular ligament (ATFL) which attaches the fibula to the talus, a tarsal bone that helps compose the ankle and ankle joint, as you can see there is a posterior one as well. Anterior and posterior refer to their location on the body, anterior basically means in front and posterior means in back. The second most common ligament to injure is the calcaneofibular ligament (CFL), which attaches the fibula to another tarsal bone in the foot, the calcaneus. The calcaneus is also the tarsal bone that makes up the heel of your foot. When inversion occurs in the ankle, the ligaments stretch out, this is clinically called a sprain. After taking my patient to the diagnostic ultrasound suite, my diagnoses had been confirmed. He had a grade 2 ATFL sprain and a grade 1 CFL sprain. Treatment for sprains include resting, icing, elevating, and compressing (RICE) the injuried area, usually via an ace bandage. We have been doing some cold laser therapy to the area which helps increase blood flow to the area which promotes a faster healing time, I'll post separately later about cold laser and it's clinical applications and research. We will eventually move to a more rehabilitative model to get his ankle back in shape, but as he has done this before, he will need to wear a brace or have his ankle taped every time he decides to participate in any sporting activity. Once ligaments are stretched out, it can take years (if ever) for them to return to normal size and shape.