Peter Markovic, DC

Spinal Biomechanical Engineering is the study of the human spine, it's function in normal positional relationship. It also offers an understanding when trauma and poor posture affect these relationships causing and bio-neuro-biomechanics of the spine. These pathological changes can be quantified, once understood and then part of a conclusive demonstrative diagnosis (visualized and verified in a reproducible posture), prognosis and treatment plan.

Spinal Biomechanical Engineering: Cervical Pathobiomechanics, Spinal biomechanical engineering of the cervical and upper thoracic spine. This includes the normal and pathobiomechanical movement of both the anterior and posterior motor units and normal function and relationship of the intrinsic musculature to those motor units. Nomenclature in reporting normal and pathobiomechanical findings of the spine.

Spinal Biomechanical Engineering: Lumbar Pathobiomechanics, Spinal biomechanical engineering of the lumbar spine. This includes the normal and pathobiomechanical movement of both the anterior and posterior motor units and normal function and relationship of the intrinsic musculature to those motor units. Nomenclature in reporting normal and pathobiomechanical findings of the spine.

Spinal Biomechanical Engineering: Lumbar Pathobiomechanics, Spinal biomechanical engineering of the lumbar spine. This includes the normal and pathobiomechanical movement of both the anterior and posterior motor units and normal function and relationship of the intrinsic musculature to those motor units. Nomenclature in reporting normal and pathobiomechanical findings of the spine.

Spinal Biomechanical Engineering & Organizational Analysis, Integrating spinal biomechanics and pathobiomechanics through digitized analysis.The comparison of organized versus disorganized compensation with regional and global compensation. Correlation of the vestibular, occular and proprioceptive neurological integration in the righting reflex as evidenced in imaging. Digital and numerical algorithm in analyzing a spine.

Spinal Biomechanical Engineering: Cervical Digital Analysis, Digitizing and analyzing the cervical spine in neutral, flexion and extension views to diagnose pathobiomechanics. This includes alteration of motion segment integrity (AMOSI) in both angular and translational movement. Ligament instability/failure/pathology are identified all using numerical values and models. Review of case studies to analyze pathobiomechanics using a computerized/numerical algorithm.

Spinal Biomechanical Engineering: Lumbar Digital Analysis, Digitalizing and analyzing the lumbar spine images to diagnose pathobiomechanics. This includes anterior and posterior vertebral body elements in rotatioal analysis with neutral, left and right lateral bending in conjunction with gate analysis. Ligament instability/failure/pathology is identified all using numerical values and models. Review of case studies for analysis of pathobiomechanics using a computerized/numerical algorithm along with corrective guidelines.

Spinal Biomechanical Engineering: Full Spine Digital Analysis, Digitalizing and analyzing the full spine images to diagnose pathobiomechanics as sequellae to trauma in relation to ligamentous failure and disc and vertebral pathology as sequellae. This includes anterior and posterior vertebral body elements in rotatioal analysis with neutral, left and right lateral bending in conjunction with gate analysis. Ligament instability/failure/pathology is identified all using numerical values and models. Review of case studies for analysis of pathobiomechanics using a computerized/numerical algorithm along with corrective guidelines.

The cervical spine undergoes a sigmoidal deformation very early after impact. During this deformation, lower cervical segments undergo posterior rotation around an abnormally high axis or rotation, resulting in abnormal separation of the anterior elements of the cervical spine, and impaction of the zygapophysial joint. Due to the shearing (translation or sliding) effect, ligamentous damage happens.

Disc injury can involve annular (outer layers of the disc) tearing without the disc herniating. There may be little to no pain or there can be unbelievable pain. This can be from mechanical structural disc pain (nerve root compression) in the intervertebral foramen or a torn annulus with a leaking disc. The recurrent meningeal nerve picks up pain from the outer disc.

differentially diagnosing spinal issues in the trauma and non-trauma patient inclusive of spinal disc pathology utilizing x-ray, MRI, CAT Scan and clinical evaluations. Collaborate triage protocols with neurologists, neurosurgeons, orthopedic surgeons, pain management and primary medical care providers with both mechanical and anatomical spine pathologies,

Report Writing and Preparing for a Legal Case, Creating demonstrative evidence, visuals of your patient's bodily injuries inclusive of x-rays, MRI's, CAT Scans and electrodiagnostic findings, the spinal biomechanics of herniated disc with ipsilateral findings and contralateral symptomatology.

Report Writing and Preparing for a Legal Case, Reviewing the facts of the case inclusive of your documentation, the defense medical examiner, medical specialists and the attorney to ensure accurate and consistent reporting.

A Documentation Relationship Between the Doctor and Lawyer, The level of organization required in a medical-legal case that accurately reflects the bodily injuries of your patients and the time constraints in rendering an accurate report.

Documentation and Cross Examination Testimony, Reporting your documentation factually and staying within the 4 corners of your medical report and scope of practice inclusive of understanding how your credentials allow you to report your documentation.

Documentation and Direct Testimony Part 4, Determininig and documenting disabilities and impairments inclusive of loss of enjoyment of life and duties under duress and the evaluation and validation of pain and suffering.

Documentation and Direct Testimony Part 3, The evaluation, interpretation and reporting of collaborative medical specialists results and concluding an accurate diagnosis inclusive of all findings and reviewing all images to ensure an accurate diagnosis.

Documentation and Direct Testimony, Organizing your documentation and understanding all collaborative documentation and how it fits into your diagnosis, prognosis and treatment plan, Understanding the nuances of the functional losses of your patients related to their bodily injuries,

Documentation and Legal Testimony, Part 2, Understanding report writing and the types of medical reports required for court inclusive of diagnosis, prognosis and treatment plans with requirements of reporting causality and permanency.

Documentation and Legal Testimony, Report writing for legal cases, the 4 corners of a narrative and documenting damages with understanding defense medical documentation and consistent reporting of bodily injuries.

The latest research on the 6 ways to age-date disc herniations and bulges from trauma inclusive of disc pathology nomenclature. MRI ordering protocols, inclusive of Dixon format and fat-suppressed images. The neurology and pathology of connective tissue and the sequella of trauma at the biomechanical level leading to bio-neuro-mechanical failure. Contemporary “evidenced-based building blocks” for triaging and in a collaborative environment.

integrating automated mensuration into creating treatment plans and determining maximum medical improvement. A literature-based study of normal vs. abnormal motor until function. Determining ligamentous laxity, alteration of motion segment integrity and pathological stress units and whole person impairments based upon the literature and academic standards,

The literature-based definitions of both the mechanisms the chiropractic adjustment and how it affects the central nervous system in pain pathways and systemic issues that is the arbiter for normal vs. abnormal function. The “physiological mechanisms” of how the chiropractic spinal adjustment affects the peripheral and central nervous systems. Subluxation degeneration/Wolff’s Law will be detailed from a literature perspective combined with the mechanism of subluxation (bio-neuro-mechanical lesion). A literature perspective why “long-term” chiropractic care is clinically indicated as usual and customary to effectuate demonstrable biomechanical changes in the spine. An evidenced-based perspective of why physical therapy is a poor choice for spine as a 1st referral option for any provider inclusive of the literature.

An academic basis for documentation that is usual and customary across professions in collaborative care. Maintaining ethical medical-legal relationships based upon Voir Dire and Duabert standards with ensuring a “4-corners” inclusive report. Ensuring Primary Care Status based upon an academic standards. Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2018

Documentation and Direct Testimony Part 2, Utilizing demonstrative documentation in direct examination and communicating the results of your care concurrently with the written documentation and reporting an accurate diagnosis for all images. A

The contemporary documentation required in a medical-legal environment that is evidenced based and meets the standards of the courts and academia. Utilizing the scientific data to support a diagnosis, prognosis and treatment plan while meeting the admissibility standards based upon a professional’s credentials.

Understanding the role of mechanoreceptors, proprioceptors and nociceptors with facets, ligaments, tendons and muscles in aberrant spinal biomechanics. MRI and imaging studies of decompressing via a chiropractic spinal adjustment of the bio-neuro-mechanical lesion and its effects on the central nervous system both reflexively and supratentorally.

The morphology and pathology of connective tissue, inclusive of spinal disc disorders and prognosticating wound repair with permanency implications. Disc bulge, herniation, protrusion and extrusion classifications based upon contemporary literature and how to age-date disc pathology.

Review of the current Centers for Disease Control [CDC} data on the frequency of musculoskeletal pain in the United States population with emphasis on pain of spinal origin. CDC guidelines on opioid medication were discussed and correlated to persistent pain syndromes. Research was reviewed showing the importance of managing the spine pain patient properly from the entry point of care with a concentration on maintenance of spinal biomechanics.

Clinical analysis of anatomic versus biomechanical spine pain and clinical triage protocols. Relating current research trends in the Whole Spine Model of patient including normal versus abnormal sagittal curvature in the adolescent and adult spine, pelvic incidence as a parameter for sagittal balance in the human spine and current methods of assessment. Patient centered approach to Evidenced Based Spine care with a focus on diagnosis, prognosis and triage of the spine pain patient.

Accurate and compliant documentation of history and clinical findings inclusive of functional losses, loss of activities of daily living, duties under duress and permanent loss of enjoyment of life. Prognosing static vs. stable care, gaps in care both in the onset and in the middle of passive care with a focus on detailed diagnosing. The integration of chiropractic academia, the court system and the insurance reimburser’s requirements for complete documentation.

The purpose of the physical examination is to detect the presence of physical, mental or organic conditions of such character and extent as to affect the drivers ability to operate a commercial motor vehicle safely. This examination is for public safety determination and is considered by the Federal Motor Carrier Safety Administration to be a "medical fitness for duty" examination.

Differential assessment of Vertigo. Consideration is given to several syndromes as well as neurological sources. A common finding auto injury is damage to the proprioceptive nerve system in the cervical spine. This type of injury causes interference between the cervical spine and the Cerebellum, causing balance issues.

When evaluating radiographs, the guidelines to keep in mind are "in order to view osseous damage on x-ray there must be at least 6 % destruction, while there needs to be only 2% damage in order to be viewed on a high field MRI".

Being vigilant to the seeming mundane daily requirement of daily practice.

Using x-rays to protect the patient. The ethical use of x-rays in ruling out injuries, permanent damage and other potential causes of the symptoms that the patient exhibits after an accident.

A review of spinal radiographs with a focus on unusual and remarkable and unusual findings.

Cervicobrachial Syndrome. This anatomical area extends from disc to the IVF to the Scalenus muscles to the clavicle and the first rib. When a patient suffers a hyperabduction type of injury, Hyperabduction Syndrome should be ruled out.

A case study of a patient with post accident arm numbness under goes an traditional laying down MRI. Results were negative. Treating physician no longer believed the patients complaint of arm pain. Patient goes to different doctor who does open MRI with Flexion/Extension views which locates the C5-6 Herniation responsible for the arm pain.

Neurodiagnostic Testing Protocols, Physiology and Indications for the Trauma Patient, Electromyography (EMG), Nerve Conduction Velocity (NCV), Somato Sensory Evoked Potential (SSEP), Visual Evoked Potential (VEP), Brain Stem Auditory Evoked Potential (BAER) and Visual-Electronystagmosgraphy (V-ENG) interpretation, protocols and clinical indications for the trauma patient.

Diagnostics, Risk Factors, Clinical Presentation and Triaging the Trauma Patient, An extensive understanding of the injured with clinically coordinating the history, physical findings and when to integrate neurodiagnostics. An understanding on how to utilize emergency room records in creating an accurate diagnosis and the significance of “risk factors” in spinal injury.

Documenting Clinically Correlated Bodily Injury to Causality, Understanding the necessity for accurate documentation, diagnosis and clinical correlation to the injury when reporting injuries in the medical-legal community. Documenting the kinesiopathology, myopathology, neuropathology, and pathophysiology in both a functional and structural paradigm.

Neurodiagnostics, Imaging Protocols and Pathology of the Trauma Patient, An in-depth understanding of the protocols in triaging and reporting the clinical findings of the trauma patient. Maintaining ethical relationships with the medical-legal community.

Documentation and Reporting for the Trauma Victim, Understanding the necessity for accurate documentation and diagnosis utilizing the ICD-9 and the CPT to accurately describe the injury through diagnosis. Understanding and utilizing state regulations on reimbursement issues pertaining to healthcare.

MRI, Bone Scan and X-Ray Protocols, Physiology and Indications for the Trauma Patient, MRI interpretation, physiology, history and clinical indications, bone scan interpretation, physiology and clinical indications, x-ray clinical indications for the trauma patient.

A nontraditional look at analyzing deficiencies, maladies and illnesses commonly suffered by many of our patients.

Determining spinal injury even at low speed, no apparent damage impacts.

Full muscular response doesn’t occur until almost the end of the loading/shearing. Shear force can cause spine sprain even before the head moves.

Even in Low impact collisions, there is a fast compressive force through the cervical spine resulting in compression, extension, acceleration and eventually the flexes, all within normal range of motion.

Focused on Post 1997 research. Dr. Panjabi introduces the latest injury model due to accidents. The Bi-phasic kinematic response to the cervical spine to whiplash trauma.

USDOT statistics show at speeds as low as 6-10 mph delta V, 3 people died, and the highest number of fatalities were at 26-30 mph delta V was 67.

Cervical muscles start to contract 100-125 milliseconds after the impact. By this time, the neck is in extension. Full muscle strength does not occur until the neck is in flexion. This confirms that injury can occur before muscle contraction.

A course designed to help integrate Chiropractors into a surgical setting. The practical application is to help patients that have unsuccessfully gone through a course of conservative care without an appreciable improvement in range of motion and a reduction of pain.

An introduction for Chiropractors to the hierarchy and departmental functions of Hospitals. This is the first Hospital to allow Chiropractors duties and privileges in an Emergency Room. This innovative move has allowed for a major financial gain for the Hospital.

A practical course in analyzing structural issues such as gait, posture and leg length differences. The entire class benefited from observing and analyzing one another and being able to ask questions of the instructor.

Shear force, the forgotten factor in the kinematics of the human spine during a rear end collision.

Early x-rays of an injury may provide a false negative for fractures. May be negative for fracture for up to 14 days. RE-XRAY if sharp pain persists.

Facet joint capsules are replete nociceptive fibers that are very susceptible to tearing, stretching and impingement during maximum physiologic values. May well be the leading cause for unexplained chronic and ongoing cervical pain.

The patients head positioning (rotation or inclination) leads to a greater severity of injury. Symptoms were evident two years post collision. A fifteen degree offset crash induces bending and twisting loads, increasing injuries.

Correlation of Cervical MRI and Computed Tomographic Discograms. Statistical analysis indicated that MRI fails to detect 27% of painful discs and is falsely positive in 33% of cases.

Providers must become more than casually acquainted with the specific provisions of the employment and workers' compensation regulations and laws in the state(s) where they are performing IMEs. This presentation offers an introductory understanding of the conceptual framework within which these evaluations occur.

This course provides an overview of forensic science through a historical perspective, how it is incorporated into the chiropractic profession and identifies the rationale for obtaining the knowledge (education), training, skill sets and experience which must be acquired to meet current qualifications as a Forensic Examiner and litigative consultant.

This course provides an overview of the AMA Guides to the Evaluation of Permanent Impairment 5th edition. It provides a historical perspective of rating textbooks and how impairment evaluation for disability systems can be incorporated into the chiropractic practice. This overview identifies the rationale for obtaining the knowledge (education), training, skill sets and experience in the use of methods of evaluation necessary to determine the presence, nature and extent of functional impairment of pain, and musculoskeletal and neurological systems utilizing the Guides.

This course has been designed to teach the chiropractic examiner to learn how to quickly and easily implement a social security evaluation after the initial rejection, based upon Social Security Administration (SSA) regulations and procedures. In addition, the course will provide some insight on how to develop skill sets and add to the knowledge base of the federal program.

Identify the physiology and nerve pathology in clinical conditions. Demonstrate a practical knowledge of the neuroanatomy, as well as clinical applications of EMG and Somatosensory and Dermatomal Evoked Potentials.

In-depth analysis of brain, neck, and cervical spine trauma mechanisms. Soft tissue injuries: a comprehensive and cutting edge analysis.

Historical documentation in personal injury and forensic medicine applications. Soft tissue healing times and implications for successful case management

Learning to accurately derive the level of impairment after an injury. Combining multiple values for a Whole Person Impairment.