Peter S. Birchler, DC Fellow, Primary Spine Care

This qualification also covers the integration of clinical correlation with imaging findings to enhance collaborative case management with medical specialists. Participants are trained to diagnose both intra- and extra-dural pathologies, such as varices and neoplasms, through advanced imaging protocols. Detailed instruction on basic and advanced sequencing is tailored to identify specific tissue pathologies effectively.

A significant emphasis is placed on spinal biomechanics and the management of non-anatomical pathology, offering an in-depth understanding of complex spinal conditions. This qualification also includes accident engineering principles, which assist in analyzing the mechanisms of injury to improve clinical outcomes. Advanced case management protocols are a central theme, ensuring practitioners can design and implement effective, evidence-based treatment plans.

Specialized topics such as electrodiagnostics, connective tissue pathology, and stroke diagnosis in a primary care setting are covered comprehensively. These advanced diagnostic skills prepare practitioners to manage a wide range of trauma-related conditions. This advanced qualification underscores a detailed understanding of trauma and its complex presentation in clinical practice.

The MRI Interpretation Review Qualification provides an in-depth understanding of MRI physics, focusing on sequencing protocols and acquisition signals. This includes training in T1, T2, STIR, T2 Fat Saturation, proton density, and Fast Spin Echo sequences in sagittal, axial, and coronal planes. Emphasis is placed on Tesla strength and image clarity, ensuring precision in imaging for accurate diagnosis.

Moreover, the program extends beyond spinal and brain imaging to include musculoskeletal (MSK) imaging of the entire skeletal system. It encompasses X-ray and MRI protocols for the shoulder, elbow, wrist, hand, and fingers in the upper extremities, as well as the hip, knee, ankle, and toes in the lower extremities. This comprehensive approach equips participants with the expertise needed for accurate imaging interpretation across diverse anatomical regions.

Credentialed in hospital protocols, emergency room protocols, acute and chronic patient triage inclusive of MRI spine interpretation, spinal biomechanical engineering, head trauma, concussion, mild traumatic and traumatic brain injuries.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

2-year program on spinal trauma, spinal management, advanced imaging, electrodiagnostics, accident engineering, spinal biomechanical engineering, triaging the injured, stroke diagnosis, demonstrative documentation, connective tissue pathology, ligament pathology diagnosis and management, and spinal treatment evidence-based outcome studies. The program requires collaboration in advanced imaging for spinal and MSK radiology and being published in case studies.

Identify and oral examination of 60 MRI sequences (over 2500 images) of disc bulges, circumferential, radial, and transverse fissures, varices, and herniations inclusive of the following types: protrusion, extrusions (sequestered and migrated/comminuted extrusions). MRI sequencing for accurate interpretation with contemporary nomenclature and reporting.

Clinically correlate history, clinical findings, and advanced spinal imaging to conclude an accurate diagnosis, prognosis, and treatment plan in an evidence-based paradigm that passes a peer-reviewed panel. The case presented must emanate from contemporary practice utilizing accepted guidelines for sequence acquisition and collaboration if clinically indicated.

The Primary Spine Care Qualification encompasses evaluating predictive models of spinal biomechanics and developing engineering paradigms for treatment plans aimed at optimizing spinal homeostasis. This process is grounded in evidence-based methodologies, ensuring that the latest scientific research supports each treatment approach. Such qualifications underscore a practitioner's commitment to delivering the highest standards of spinal care, leveraging data-driven conclusions for effective outcomes.

The Primary Spine Care Qualification is a comprehensive program designed to equip practitioners with the expertise to triage patients with spinal injuries and coordinate collaborative care throughout the entire continuum of recovery. It encompasses the full spectrum of spinal MRI interpretation, including the identification of disc pathology, intradural tumors, and other space-occupying lesions. Additionally, the curriculum provides detailed instruction on MRI protocols to ensure accurate and effective diagnoses, enabling practitioners to deliver evidence-based care tailored to each patient's unique needs.

This advanced qualification integrates graduate-level medical and chiropractic education to provide comprehensive expertise in triaging injured patients. Training begins with a strong foundation in patient history-taking, clinical examination, and basic imaging, equipping practitioners with the essential tools to effectively assess and diagnose trauma cases. Advanced imaging modules focus on mastering MRI spine interpretation, enabling practitioners to identify and differentiate conditions such as herniated, bulged, protruded, and extruded discs with precision.

Evidence-based studies in Modic Changes, Disc and Referred Pain, MRI and Cervical Musculature, Kinetic MRI Images, Neurological Innervation, MRI and Injury Mechanisms, Discogenic Pain, Annular Tears and Fissures, Asymptomatic Herniations.

MRI, CAT Scan, and X-ray interpretation of shoulder, elbow, wrist, hand, fingers. Identifying tumors, fractures, dislocations, and infections in joints, including the long bones attached to the joints.

MRI, CAT Scan, and X-ray interpretation of shoulder, elbow, wrist, hand, fingers. Identifying soft tissue injuries in joints; labrum, meniscus, and ligament and tendon injuries.

MRI, CAT Scan, and X-ray interpretation of pelvis, hips, knee, ankle, foot, and toes. Identifying arthridities in upper extremities.

Review of spinal ligament and disc anatomy. Training on biomechanical analysis of global and segmental spinal motion. Demonstrable documentation and reporting of AOMSI by xray digitizing software.

Magnetic fields, T1 and T2 relaxations, nuclear spins, phase encoding, spin echo, T1 and T2 contrast, magnetic properties of metals and the historical perspective of the creation of NMR and MRI.

Normal anatomy of axial and sagittal views utilizing T1, T2, 3D gradient and STIR sequences of imaging. Standardized and desired protocols in views and sequencing of MRI examination to create an accurate diagnosis in MRI.

MRI interpretation of bulged, herniated, protruded, extruded, sequestered and fragmented disc pathologies in etiology and neurological sequelae in relationship to the spinal cord and spinal nerve roots.

MRI interpretation of bone, intradural, extradural, cord and neural sleeve lesions. Tuberculosis, drop lesions, metastasis, ependymoma, schwanoma and numerous other spinal related tumors and lesions.

MRI interpretation sequencing of the cervical, thoracic and lumbar spine inclusive of T1, T2, STIR and 3D gradient studies to ensure the accurate diagnosis of the region visualized.

The clinical application of the results of space occupying lesions. Disc and tumor pathologies and the clinical indications of manual and adjustive therapies in the patient with spinal nerve root and spinal cord insult as sequela.

MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images. Clinical indication for the utilization of MRI and pathologies of disc in both trauma and non-trauma sequellae, including bulge, herniation, protrusion, extrusion and sequestration.

MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of lumbar degeneration. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl/’s nodes and herniations. Central canal and cauda equine compromises interpretation with management.

MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of lumbar herniations. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl/’s nodes and herniations. Morphology of lumbar disc pathologies of central and lateral herniations, protrusions, extrusions, sequestration, focal and broad based herniations are defined and illustrated. Central canal and cauda equine compromise interpretation with management.

MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of cervical degeneration. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl/’s nodes and herniations. Spinal cord and canal compromise interpretation with management.

MRI slices, views, T1, T2, STIR axial, FFE, FSE and sagittal images in the interpretation of cervical herniations. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl/’s nodes and herniations. Morphology of cervical disc pathologies of central and lateral herniations, protrusions, extrusions, sequestration, focal and broad based herniations are defined and illustrated. Spinal cord and canal compromise interpretation with management.

MRI slices, views, T1, T2, STIR axial, FFE, FSE and sagittal images in the interpretation of degenerative spondylolisthesis, spinal canal stenosis, Modic type 3 changes, central herniations, extrusions, compressions, nerve root compressions, advanced spurring and thecal sac involvement from an orthopedic, emergency room, chiropractic, neurological, neurosurgical, physical medicine perspective.

A Department of Human Services-approved training fulfilling Act 31 requirements, focused on identifying signs of child abuse, understanding legal obligations of mandated and permissive reporters, and procedures for reporting suspected abuse. Emphasized legal definitions, reporting protocols, and protections for reporters.

in-depth analysis of immunologic and non-immunologic pathophysiology, histamine-mediated and bradykinin-mediated pathways, autoimmune and idiopathic urticaria, complement system involvement, dermatographic responses, pharmacologic triggers, and evidence-based management strategies including antihistamines, biologics (omalizumab), corticosteroids, and epinephrine in acute care. Clinical considerations addressed from dermatologic, allergologic, immunologic, emergency, and internal medicine perspectives.

Focused instruction on the immunologic and non-immunologic mechanisms of anaphylaxis, including IgE-mediated and idiopathic reactions, mast cell degranulation, cytokine release, biphasic and refractory presentations, and differential diagnosis from mimicking conditions such as vasovagal syncope and anxiety-induced responses. Emphasis on rapid clinical recognition, risk stratification, and advanced treatment protocols including intramuscular epinephrine administration, adjunctive therapies (antihistamines, corticosteroids, beta-agonists), airway management, and post-episode observation. Clinical considerations explored from emergency medicine, internal medicine, allergy/immunology, and primary care perspectives.

Comprehensive instruction in immune system architecture and function, including innate and adaptive immunity, hypersensitivity reactions (Type I–IV), antigen presentation, immunoglobulin class functions, cytokine signaling, and the pathophysiology of allergic diseases such as asthma, atopic dermatitis, allergic rhinitis, and food allergies. Course emphasis on immune tolerance, autoimmunity, immunodeficiency syndromes, and current diagnostic modalities including skin testing, serum IgE assays, and component-resolved diagnostics. Clinical applications discussed from allergy/immunology, dermatology, internal medicine, pediatrics, and pulmonary medicine perspectives.

Provided advanced training in pediatric assessment and care, including instruction in the pre and post-natal maternal care and Webster Technique. Covered clinical evaluation and management of concussion, pediatric physiology, developmental milestones, infant adjustive technique, and rehabilitation strategies. Included evidence-based nutritional recommendations for common childhood illnesses and guidance on distinguishing normal from abnormal development

Focused on the immune response to Borrelia burgdorferi infection, chronic inflammation, and neurological manifestations of Lyme disease. Covered chiropractic and integrative strategies for managing persistent symptoms, including detoxification support, nutritional therapy, and neuroimmune regulation. Emphasized non-pharmacological care models and interdisciplinary collaboration

Detailed instruction on IgE-mediated food allergy mechanisms, non-IgE-mediated and mixed-type allergic responses, and differentiation from food intolerances and sensitivities. Emphasis on clinical recognition of acute and delayed hypersensitivity reactions, including anaphylaxis, oral allergy syndrome, and eosinophilic gastrointestinal disorders. Covered diagnostic methodologies such as skin prick testing, specific IgE testing, oral food challenges, and component-resolved diagnostics. Treatment strategies included elimination diets, epinephrine auto-injector use, emergency response planning, and emerging therapies such as oral immunotherapy (OIT). Clinical relevance addressed from allergy/immunology, pediatrics, emergency medicine, gastroenterology, and primary care perspectives.

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.

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.

An extensive understanding of the physics involved in the transference of energy from the bullet car to the target car. This includes G's of force, newtons, gravity, energy, skid marks, crumple zones, spring factors, event data recorder and the graphing of the movement of the vehicle before, during and after the crash. Determining the clinical correlation of forces and bodily injury.

MRI interpretation, physiology, history and clinical indications, bone scan interpretation, physiology and clinical indications, x-ray clinical 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.

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.

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.

A Department of Human Services-approved training fulfilling Act 31 requirements, focused on identifying signs of child abuse, understanding legal obligations of mandated and permissive reporters, and procedures for reporting suspected abuse. Emphasized legal definitions, reporting protocols, and protections for reporters.

Advanced radiologic protocols and positioning techniques for accurately imaging individuals with chronic musculoskeletal and neurological impairments. Covered adaptations for limited mobility, post-surgical hardware, and spinal deformities, with emphasis on diagnostic accuracy, safety, and interdisciplinary care considerations.

Covered radiographic evaluation of acute and chronic athletic injuries, including fractures, ligament tears, tendonopathies, and stress injuries. Emphasized appropriate imaging modalities (X-ray, MRI, CT, ultrasound), positioning techniques, and interpretation principles to support diagnosis, treatment planning, and return-to-play decisions.

Clinical and radiologic identification of scaphoid fractures, including anatomical considerations, fracture classifications, and mechanisms of injury. Emphasized early detection, appropriate imaging modalities, complications such as avascular necrosis, and both conservative and surgical management strategies.

Addressed the technical and clinical difficulties in imaging obese patients, including positioning limitations, image quality reduction, and equipment considerations. Covered protocol modifications, modality selection (X-ray, CT, MRI, ultrasound), and strategies to improve diagnostic accuracy and patient safety in this growing patient population.

The three most common mistakes in thyroid assessment. Myths and truths about iodine supplementation. The three best ways to assess thyroid and adrenal function, and blood sugar balance. The four keys to patient compliance with your supplementation programs. The seven nutritional minerals necessary for the health of these three endocrine areas.

Nutritional strategies to support healthy aging and reduce the risk of age-related chronic diseases. Covered metabolic changes with age, micronutrient needs, inflammation control, and lifestyle interventions to preserve cognitive function, musculoskeletal integrity, and cardiovascular health. Emphasized practical, evidence-based approaches to patient care.

Provided in-depth training on chiropractic billing, coding, and documentation standards to ensure regulatory compliance and maximize reimbursement. Covered CPT coding, ICD-10 specificity, Medicare guidelines, documentation requirements, and audit preparedness. Emphasized ethical practices and integration of compliance protocols in daily clinical operations.

Examples of how environmental events both toxic and nutritional can influence/activate/suppress genetic expression. Case studies referencing known disease expressions proven to be influenced by genetic predisposition. Patient assessment techniques- including seven primary, unified mechanisms of nutritional physiological support.

Explored the interrelationship between glycemic control, adrenal function, and hormonal balance in women. Covered nutritional and herbal interventions for insulin resistance, adrenal fatigue, and estrogen/progesterone imbalances. Emphasized clinical assessment, functional lab interpretation, and integrative treatment strategies to support female metabolic and endocrine health

Explored the integration of nutritional strategies with chiropractic care to support musculoskeletal health and reduce systemic inflammation. Covered the role of diet, supplementation, and lifestyle in managing chronic pain, tissue healing, and inflammatory conditions. Emphasized evidence-based approaches to enhance patient outcomes through combined structural and metabolic support.

Explored the neuroanatomy and neurophysiology of pain perception, including peripheral and central sensitization, pain pathways, and the role of the thalamus, cortex, and spinal cord. Covered mechanisms of acute and chronic pain, neuropathic vs. nociceptive pain, and clinical implications for diagnosis and management.

Diagnosis and clinical management of common spinal pain conditions, including discogenic pain, facet syndrome, radiculopathy, spinal stenosis, and myofascial dysfunction. Emphasized pain generators, biomechanical contributors, and evidence-based approaches to evaluation and treatment within chiropractic and interdisciplinary care models.

Introduced principles of functional assessment and rehabilitation in chiropractic practice. Focused on movement pattern analysis, postural evaluation, and identifying functional deficits contributing to pain and dysfunction. Emphasized goal-oriented, patient-centered care to restore mobility, stability, and neuromuscular control.

Advanced application of functional assessment and corrective strategies in chiropractic care. Built upon foundational principles to address complex movement dysfunctions, neuromuscular imbalances, and kinetic chain deficiencies. Emphasized progressive rehabilitation protocols, functional outcome tracking, and integrating care with performance-based patient goals.

Provided foundational training in the role of nutrition in supporting the cardiovascular, endocrine, digestive, musculoskeletal, and immune systems. Covered nutrient functions, clinical indications for supplementation, and diet-based interventions to promote systemic balance and optimize health outcomes.

Explored the application of diagnostic imaging in the evaluation and management of sports-related injuries. Focused on radiographic positioning, modality selection (X-ray, MRI, CT, ultrasound), and interpretation principles for musculoskeletal trauma, overuse injuries, and post-surgical assessment in athletic populations.

Enhancing provider-patient interactions to improve clinical outcomes, patient satisfaction, and adherence to care plans. Covered strategies for active listening, motivational interviewing, cultural competence, and delivering difficult information with clarity and empathy in chiropractic and interdisciplinary healthcare settings.

Focused on the biomechanical, hormonal, and postural changes associated with pregnancy and their impact on spinal and pelvic alignment. Included training in safe chiropractic techniques across all trimesters, including the Webster Technique, and emphasized maternal comfort, fetal positioning, and interdisciplinary care. Also covered recognition of pregnancy complications such as preeclampsia, gestational diabetes, and placental issues, along with interpretation of common prenatal diagnostics to ensure safe and informed chiropractic management.

Provided comprehensive training in chiropractic assessment and adjustment of upper and lower extremities. Topics included management of sports injuries, carpal tunnel syndrome, temporomandibular joint (TMJ) dysfunction, and the "Magnificent 7" extremity protocols. Emphasized hands-on technique, clinical integration, and communication within multi-disciplinary healthcare teams.

Focused on the identification and interpretation of neurological signs and symptoms in the chiropractic setting. Covered cranial nerve assessment, deep tendon reflex testing, sensory and motor evaluation, cerebellar function, and gait analysis. Emphasized the integration of neurological findings with musculoskeletal complaints to improve differential diagnosis, referral decisions, and care planning. Included case-based applications for conditions such as radiculopathy, myelopathy, neuropathy, and central nervous system disorders. Designed to enhance clinical competency in neurologic screening and patient safety within chiropractic practice.

Radiographic evaluation of total knee arthroplasty, including proper imaging positioning, component alignment assessment, and identification of complications such as loosening, infection, or malposition. Emphasized diagnostic accuracy and interpretation within chiropractic and multidisciplinary settings.

Examined strategies to reduce antimicrobial resistance in clinical settings, including infection control protocols, antibiotic stewardship, and recognition of multidrug-resistant organisms. Emphasized prevention methods, cross-discipline communication, and evidence-based practices to enhance patient safety and reduce healthcare-associated infections.

A case-based seminar focused on real-world chiropractic clinical experiences and problem-solving in complex patient presentations. Covered diagnostic challenges, treatment pitfalls, patient communication strategies, and interdisciplinary coordination. Emphasized practical lessons, clinical reasoning, and outcome-driven care based on decades of hands-on chiropractic practice.

Explored the scientific basis of paleo nutrition and its role in preventing chronic disease linked to modern dietary patterns. Covered evolutionary biology, inflammatory pathways, and clinical research on nutrition-related conditions. Emphasized practical dietary strategies for restoring innate health.

Examined the clinical impact of common nutritional deficiencies and the role of targeted supplementation in disease prevention and wellness care. Topics included omega-3 fatty acid deficiency, vitamin D insufficiency, probiotic use for gut dysbiosis, and multivitamin/mineral/phytochemical support. Emphasized research-backed protocols for optimizing patient health.

Focused on integrating functional rehabilitation and performance enhancement into chiropractic care. Covered movement screening, corrective exercise, neuromuscular re-education, and strength and conditioning principles to improve patient outcomes. Emphasized building individualized programs to support recovery, injury prevention, and long-term performance

Examined the neurology of neurodevelopmental disorders such as ADHD, autism spectrum disorders, and sensory processing dysfunction. Focused on the chiropractic impact on nervous system function and its role in co-management of pediatric neurodevelopmental cases. Emphasized neurologically-based care, interdisciplinary collaboration, and support for optimal developmental outcomes.

A comprehensive training required for American Chiropractic Registered Radiologic Technologist (ACRRT) certification. Covered radiation safety protocols, radiographic positioning techniques, and foundational X-ray physics. Emphasized best practices for patient protection, image quality, and regulatory compliance. Successfully completed with passing registration from ACRRT.

No mater if your vehicle was involved in a rear-end accident, sideswipe or head-on collision, some serious injuries were most likely suffered. Car crashes, workplace accidents, and slip and falls are all common personal injury incidents that can require chiropractic treatment. Chiropractic care can help you recover from whiplash, sprains and strains, herniated discs, and many more musculoskeletal injuries caused by car accidents.