Red Flags & Referrals

Recognition and management of urgent/serious medical conditions

L.Ac.’s role as primary health-care profession
Condition incidence and/or prevalence in outpatient acupuncture practice
Risk factor/history/sign/symptom clusters
Pathomechanisms, natural progression and adverse outcomes
Stabilizing measures, referrals, consultations, and EMS
Documentation of assessment, stabilization and referral

General characteristics of pain as a red flag

Timing of pain
Post-traumatic and post-surgical pain
Atraumatic joint inflammation and degeneration
Bone pain and fractures
Pain with neurovascular and trophic signs and symptoms
Degree of disability

Spinal pain, sensory and motor problems

Radiculopathy
Cauda equina syndrome
Spinal cancer
Fractures: vertebral compression, ribs, spondylolisthesis
Shingles/herpes zoster

Upper extremity pain, sensory and motor problems

Rotator cuff tears
Shoulder, elbow, wrist dislocation
Fractures: radial head and neck; supracondylar; scaphoid
Severe peripheral neuropathy
Severe Raynaud’s disease
Complex regional pain syndrome: reflex sympathetic dystrophy, causalgia

Lower extremity pain, sensory and motor problems:

Avascular necrosis of the hip
Slipped capital femoral epiphysis
Vascular claudication
Ankle/foot fractures
Deep vein thrombosis/pulmonary embolism
Compartment syndrome

Headaches and oro-facial pain

TIAs, strokes and aneurysms
Temporal arteritis
Bacterial sinusitis
Acute closed-angle glaucoma
Non-traumatic subarachnoid hemorrhage
Severe sore throat

Organ pain

Chest and respiratory pain
Abdominal and digestive pain
Urinary and reproductive systems pain

Systemic and Psycho-Social Complaints

Limb swelling and pulse abnormalities
Fatigue and changes in weight
Dizziness and altered mental function
Substance abuse, depression and suicidality
Signs and symptoms of abused and neglected patients

Making and Building Referrals

The art of building referral relationships to enhance patient safety and volume.
Protocols for effective and timely referrals
Documentation of management and referrals

Recommended text: An Acupuncturist’s Guide to Medical Red Flags and Referrals, David Anzaldua, M.D.

Stabilizing and Mobilizing Joints With Prolo-Acupuncture

Ligaments, or 韧带 rèndài

join bones to bones, and may be considered part of the 经筋 jīngjīn, or myofascial/sinew meridians. Yet assessing and treating ligament injuries is literally a “missing link” in much acupuncture training regarding musculoskeletal pain and disability. Simple and easily-learned techniques for needling ligaments can stimulate self-repair and improve outcomes by helping to:

Accelerate healing and reduce chronicity from acute sprains/strains;
Re-stabilize hypermobile joints, and restore normal joint tracking and biomechanics;
Slow and allow for reversal of joint degeneration that leads to osteoarthrosis;
Enhance the treatment of muscles, nerves, and other tissues and systems that contribute to chronic pain.

Ligaments and Joints Covered:

Shoulder, Arm and Hand

Acromio-clavicular joint: sprains, separations, chronic hypermobility
Gleno-humeral joint: sprains, AMBRI, TUBS and SLAP lesions
Transverse humeral ligament: bicipital tendon subluxations
Elbow collateral ligaments: sprains, subluxations
Wrist ulnar- and radio-carpal ligaments and the triangular fibrocartilage complex: sprains, tears, chronic hypermobility

Hip, Knee, Ankle and Foot

Knee patellar, collateral and cruciate ligaments: sprains, chronic hypermobility
Knee menisci and the tibio-meniscal ligament: sprains, degeneration
The superior and inferior tibio-fibular joints: sprains, chronic hypermobility
Lateral ankle/foot: ATF, CF, PTF and CC ligaments: sprains, chronic hypermobility
Medial ankle: hyper-pronation, deltoid and spring ligaments: chronic hypermobility

The Spine

Cervical and lumbar facet joints: sprains, dysfunction, chronic hyper- and hypo-mobility
Posterior sacro-iliac, ilio-lumbar and sacro-tuberous ligaments: dysfunctions, degeneration
Supraspinous ligament: whiplash, sprains

Anatomy and Patho-anatomy

Functional/clinical anatomy, patho-anatomy of the main and commonly-injured joints of the body, in AOM and standard contemporary medical terms
Common etiologies and prognoses for common injuries and pain of the major joints of the body, in AOM and standard contemporary medical terms

Assessment

Performing a physical exam for common injuries and pain of the major joints of the body, including observation, inspection, palpation and special orthopedic tests for joint range-of-motion, tracking and end-feel/stability
Red flags for serious/urgent joint injuries and pain that warrant referral to physician care

Treatment

Treatment for common joint injuries with acupuncture, including ligamentous prolo-acupuncture (“dry”) needling, electro-acupuncture, and 7-star needling.

Elbow and Forearm Review and Practicum Lab

Practice, apply, re-inforce and expand upon physical examination and treatment techniques taught in the associated didactic module.
Labs focus on areas of particular technical difficulty, and provide an opportunity for presentation, demonstration treatment and discussion of challenging cases.
Note: Practicum/Review Labs are open only to participants who have completed the prior associated didactic module: Elbow, Forearm, Wrist, Hand.

Elbow joint review:

Joint play and end-feel testing
Ligamentous prolo-acupuncture for elbow joint re-stabilization

Elbow and forearm muscle review: manual strength testing, trigger point needling, and gua sha therapy

Triceps brachii
Biceps brachii and supinator
Pronators teres and quadratus
Brachialis
Brachioradialis

Wrist joint review:

Joint-play/end feel testing: ulnar-carpal, radio-carpal, and distal radio-ulnar joints
Ligamentous prolo-acupuncture for wrist joint re-stabilization

Forearm and wrist muscle review: manual strength testing, trigger point needling, and gua sha therapy

Flexors carpi ulnaris and radialis
Extensors carpi ulnaris and radialis

Hand and finger joint review:

Joint-play/end feel testing: carpo-metacarpal, metacarpo-phalangeal, and interphalangeal joints
Ligamentous prolo-acupuncture for wrist joint re-stabilization

Hand and finger strength testing review: dynanometer measurement

Grip strength
Pinch strength
Manual testing

Case presentation/demonstration treatment and discussion

Myofascial Trigger Point Acupuncture

Acupuncture and myofascial trigger point needling: what's the difference?
History and physical exam findings, indications for needling of myofascial trigger points
Safety, side-effects, contraindications, cautions, patient education and informed consent
Ways to develop skills in myofascial trigger point needling
East-West anatomy and physiology of myofascial trigger points
Locating and needling myofascial trigger points in the following muscles:
- Arm Taiyang Jing-Jin: The superficial posterior tract
  - Triceps brachii
  - Infraspinatus & teres minor
  - Levator scapula
- Leg Taiyang Jing-Jin: The superficial posterior tract (continued)
  - Trapezius
  - Erector spinae
  - Hamstrings
  - Gastrocnemius, soleus and Achilles tendon
- Shaoyang Jing-Jin: The superficial lateral tract
  - Supraspinatus
  - Quadratus lumborum
  - Gluteus medius and minimus
  - Tensor fascia lata and IT band
- Yangming Jing-Jin: The superficial anterior tract
  - Lateral pterygoids
  - Iliopsoas
  - Quadriceps
- 3 Yin Jing-Jin: The medial and central tracts
  - Pectoralis minor
  - Subscapularis

Professional Ethics and Risk Management

Professional Ethics & Risk Management --Live Webinar with Anthony Von der Muhll

Monday December 11, 9:00-6:00, Pacific Time

8 Safety & Ethics PDAs/CEUs Category 1 pending

Is your practice safe?

Do you know what the new CNT manual (7th ed.) recommends for minimizing pneumothorax risks? Sterilizing cups, gua sha tools? Preventing heat lamp and moxa burns? Medical record-keeping?
Do you routinely provide a "best-practices" informed consent before treatment?
Do you know what social media marketing techniques are legal vs. illegal, as well as what terms to avoid using on your website?
Do you know how to avoid triggering insurance audits for suspected over-billing?
Can you recognize when you're in a "high-risk" relationship with a patient, and manage the situation without charges of discrimination in health care or "patient abandonment" that risk license suspension?
What would you do/not do if you were concerned someone was going to file a malpractice suit against you?

If you're unsure, this Class/E-book is for you!

If you took the CNT certification exam prior to 2015, reviewing the 7th ed. of the CNT Manual is critical, as there have been many significant changes that have re-shaped standards of care and essential risk management strategies for the profession. Knowing and following the guidelines of the CNT Manual, 7th ed. minimizes risks for your and your patients!

I invite you to benefit from my experience as an Expert Witness in malpractice litigation, complaints to regulatory boards, and insurance audits to help you manage risks while supporting sustainable practice growth.

--Anthony Von der Muhll, L.Ac., DNBAO, DAOM

Topics Include

Review of critical recommendations of the Clean Needle Technique Manual, 7th ed. and standards of care regarding frequently-litigated injuries
- Pneumothorax and other organ punctures
- Nerve traumas
- Burns, scarring and infections
- Slip-and-fall injuries
- Failure to diagnose, manage and refer
Essential strategies to reduce risks of malpractice and complaints to regulatory boards, and manage them if they occur, including informed consent and documentation, and maintaining alignment of patient-practitioner goals
Recognizing and managing higher-risk patients and patient relationships, while avoiding discrimination or abandonment
Truth in advertising: representation of title, training, prognosis, outcomes
Fiduciary duties: fee-setting and -splitting, discounts, insurance billing, product sales
Clarifying the scope of practice "gray areas"

Report-Writing for Managed Care: HMO, Personal Injury, Work Comp

Need CAB CEUs? Contact us

Live classes and webinars feature instructor-lead peer review/feedback regarding chart notes, and comparison of electronic and on-line documentation systems

Medical report-writing skills are vital for treatment authorization requests and reimbursement for HMO, Personal Injury and Workers Compensation cases. Review and apply best practices for the particular requirements of managed care, including:

Initial and follow-up evaluations: setting treatment goals, present outcomes, and making recommendations for future care to support reimbursement and treatment authorization/re-authorization requests
Comparison of electronic health records systems for managed care reporting
Using standardized functional capacity questionnaires to measure subjective assessments of progress
Pain scales: how to use them accurately and reliably
Specific requirements of the California Workers Compensation system: initial and progress reports (PR2s)
Documentation and reporting of objective measurements of functional capacities and other key baselines, including:
- Findings from observation and inspection
- Joint range-of-motion, tracking and stability
- Muscle strength
- Sensory function
- Tenderness
- Limb girth and skin lesions
- Orthopedic and neurologic assessments
- Special tests and physical examinations for other body systems
- Non-quantifiable assessments of functional capacity

Distance learning/self-study, E-book and live class notes feature sample initial functional capacity evaluations and re-evaluation reports for managed care insurance.

Live class features instructor-lead peer review/feedback regarding student reports.

***Please note: For Certification in Acupuncture Orthopedics, either the live class (8 hours/CEUs/PDAs), or the distance-learning class (5 hours CEUs/PDAs) + one live 3-hour clinical case mentorship meeting focused on medical documentation (no CEUs/PDAs) is required.***

Building Your AOM Practice

Workshop Topics:

Key metrics to track for business development.
Insurance billing basics, and whether to join–or quit–managed care networks
Practice and risk management essentials
Customer service: keys to success!
Building a thriving practice through cultivating medical referrals
Why and how to avoid social media marketing--you can do it, using no-cost and efficient marketing strategies!
The golden parachute: planning and selling your practice for maximum value

Who should take this class:

AOM students planning their future practice
Recently-licensed acupuncturists
Those transitioning to a new practice model or location
Those re-entering the profession
Anyone who wants support in starting and building a safe, sustainable and satisfying practice!

Participants receive:

A “starter kit” of sample spreadsheets, clinic operating procedures, and marketing and educational materials
On-going access to class notes and discussion forums

This class builds on the topics covered 9:00 a.m.-1:00 p.m. in Starting Your AOM Practice: securing locations and rental/employment agreement terms that work for you and your patients; business planning essentials (financing, fee-setting, and appointment schedules) and more. Take both classes for -10% off each!

Calf, Ankle & Foot — Review and Practicum Lab

Mon July 11, 2022, 9:00-6:00 p.m. PDT at 1600 Broadway, Oakland CA
PDAs & CEUs approved

Course Content

Practice, apply, re-inforce and expand upon physical examination and treatment techniques taught in the associated didactic module.
Labs focus on areas of technical difficulty, and provide an opportunity for presentation, demonstration treatment and discussion of challenging cases.
Note: Practicum/Review Labs are opens only to participants who have completed the prior associated didactic module: Calf, Ankle and Foot.

Calf, Ankle & Foot Physical Exam

Ankle, foot, and toe joint review:
- AROM assessment
- Joint play and end-fee testingl
- Joint stabilization prolo-acupuncture
Calf muscle review: manual strength testing, trigger point needling, gua sha and tui na therapies
- Plantarflexors + invertors
- Plantarflexors + evertors
- Dorsiflexors + invertors
- Dorsiflexors + evertors
Ankle and foot protective and corrective therapies review
- Taping techniques
- Ankle stability and control exercises
- Calf strengthening and stretching

Case presentation/treatment demonstration and discussion

What You Need to Succeed: Essential Skills in Managing Pain

Map out your path to clinical success in orthopedics and pain management! Participants will gain many immediately applicable take-home techniques and strategies, as well as an overview of how to develop knowledge, abilities, and marketability to compete in this rapidly-growing area of AOM specialization. If you are considering certification in Integrative Acupuncture Orthopedics through AOM Professional or advanced studies in orthopedics anywhere, this class is a great place to start!

Understanding Chronic Pain: Essential Knowledge

Acupuncture and the opioid epidemic: opportunities, risks, challenges and roles for acupuncturists
Understanding pain as a subjective perception of past, current or potential tissue damage
Neural sensitization: a common mechanism in chronic pain
Neuromusculoskeletal anatomy: surface (palpatory), sub-surface, kinesiology, kinematic chains, the jing-jin ("myofascial meridians") tissue histology
Patient communication and education: managing and transforming maladaptive hopes, expectations, fears, assumptions, beliefs, habits, behaviors

Paradigm shift: from passive pain relief to pro-active functional restoration
Pain psychology and behaviors: a five-element perspective
Explaining acupuncture mechanisms and effects to patients and other medical professionals

Essential Skills for Working in Integrative Pain Management

Communication with other providers: roles and the licensure hierarchy
Medical documentation & report-writing for coordination of care and referral-building
Patient/condition selection: knowing the strengths and limits of your knowledge, skills, and abilities

Essential History and Physical Exam Skills in Pain Management

Neck and shoulder pain as an example

Ruling out urgent conditions
Active range-of-motion
Passive range-of-motion and joint play testing
Manual strength testing
Reflex and sensory testing

AOM Treatment by Tissue and Pattern Identification

Neck and shoulder pain as example

Myofascial trigger point acupuncture
Myofascial gua sha
Electroacupuncture
Advanced cupping for orthopedics: passive mobilization, active movement, and "wet" cupping
Lancet, 3-edged and 7-star needling
Disruptive-proliferative ("prolo-") ligamentous -and tendino-periostial acupuncture
Distant needling

Exercise Therapy for Acupuncturists

Need CAB CEUs? Contact us

"Is there anything I can do on my own to treat this?

"Should I do this exercise my fitness trainer showed me, even though it hurts?"

"I want to get more cardio and lose weight. Should I run, swim, or bike?"

"When can I go back to my gym workout/yoga class/marathon training?"

How often do we hear our patients ask questions like this? Now you'll have some better answers...

Easy-to-teach exercises can improve clinical outcomes by actively involving patients in self-care, and can complement AOM modalities. Drawing from qi gong, yoga, Pilates, and other techniques, we will discuss exercises for specific injuries to help patients to:

Reduce stress, muscle tension, pain, anxiety and depression
Accelerate healing and reduce chronicity of sprain/strain injuries
Re-stabilize hypermobile joints, and restore normal joint tracking and biomechanics
Slow and allow for reversal of joint degeneration that leads to osteoarthrosis
Enhance the treatment of muscles, nerves, and other tissues and systems that contribute to chronic pain
Maintain bone density, muscle strength and flexibility, coordination, and balance to reduce the risk of falls and injuries
Support the patient in an active lifestyle and meeting their goals for health, fitness, work, sports and recreation
Improve health of internal organs; the cardiovascular, lymphatic, endocrine & immune systems; mind, mood, & sleep; & overall quality & quantity of life.

Topics include:

When to prescribe--or "un-prescribe" exercises: post-injury/surgery, chronic pain, and health maintenance
How best to co-manage patients with physical therapists and surgical rehabilitation teams
Which exercises can patients safely and effectively perform at home, for what body regions, systems, and injuries
Analyzing common qi gong, yoga, Pilates, gym workouts, etc. for their risks and benefits, from an integrative East-West orthopedic and neurologic perspective
Adapting exercises for specific conditions and patients
How to integrate exercise therapy into the flow of a busy acupuncture clinic
Scope-of-practice, coding, billing and malpractice considerations

And what's good for our patients is good for us--we'll review self-care exercises and ergonomics for acupuncturists!

General considerations in exercise therapy

Review of L.Ac. scope-of-practice issues
Risks and benefits: when to prescribe, un-prescribe, or refer out for co-management
Co-managing with physical therapists: phases, benchmarks and goals of post-injury/surgery rehabilitation
Exercise cautions and contraindications
Differentiating exercise-induced injury vs. therapeutic delayed onset muscle soreness
Prescription essentials: timing, sequence, repetitions, sets, duration, intensity, frequency

Roles of and indications for specific exercise techniques and styles:

Functional re-training: activities of daily living, work ergonomics, recreation and sports
Stress reduction: qi gong and breathing exercises
Flexibility: passive and active stretching, static and flow yoga styles
Neurologic re-training and coordination
Strengthening and stabilization exercises
Joint loosening warm-ups, reciprocal inhibition, and abdominal bracing to improve safety and efficacy across all exercise styles
Cardiovascular exercise for general health
Assessing exercise prescription from the viewpoint of jing-jin and zang-fu imbalances

Exercise prescription for specific body regions, injuries and pain

Spinal exercise prescription: upper body
- Cervical stabilization
- Thoracic mobilization
Upper extremity exercise prescription
- Scapular stabilization and shoulder strengthening
- Elbow, forearm and wrist exercise therapy
Spinal exercise prescription: lower body
- Core/lumbar stabilization
Lower extremity exercise prescription
- Hip strengthening and mobilization
- Knee stabilization
- Calf, ankle and foot rehabilitation
Putting it all together: posture, gait and ergonomics

Integrating exercise prescription into an acupuncture clinic

Combining exercise with manual therapy and cupping in the same visit
Tools, supplies, and space considerations
Documentation, coding and billing for therapeutic exercise
Stand-alone exercise classes: insurance, scope of practice and malpractice considerations
Exercise knowledge and skill development for acupuncturists

Coaching patients on health maintenance through exercise

Working with patient’s exercise readiness, compliance, tolerance and goals
Home programs and telemedicine consults
Group classes vs. individualized training
Cardiovascular exercise options and prescription
Recognizing limits and injuries; managing exercise-induced delayed-onset muscle soreness

To get the most out of this class, please wear workout clothes and shoes, and bring the following exercise tools, which you will be able to use later in your clinic. Exercise equipment will not be provided.

One or more pairs of dumbbells in the 2-10 lb. range (a pair of 8-oz soup cans will do)
Resistance tubing/bands of light-moderate gauge; also, squeeze balls, rings
A wobble cushion/disc (e.g. “dynadisc”)
6” diameter rigid foam roller
Yoga/exercise mat + straps or belts

Links are for informational purposes only and do not represent product endorsements. Anthony Von der Muhll does not have any financial relationship with exercise equipment makers or vendors.

Recognition and Management of Serious/Urgent Medical Conditions

With Instructor Anthony Von der Muhll, L.Ac., DNBAO, FAIPM

Course Goals and ContentOn-Demand/Home Study Class

Recognition and management of urgent/serious medical conditions

General characteristics of pain as a red flag

Spinal pain, sensory and motor problems

Systemic and Psycho-Social Complaints

Making and Building Referrals

Student Ratings and Comments

Next offering: TBA. Please let us know of your interest in a distance-learning class.

With Instructor Anthony Von der Muhll, L.Ac., DAOM, DNBAO, FAIPM

Ligaments, or 韧带 rèndài

Ligaments and Joints Covered:

Shoulder, Arm and Hand

Hip, Knee, Ankle and Foot

The Spine

Anatomy and Patho-anatomy

Assessment

Treatment

Next offering: TBA. Please let us know of your interest in a distance-learning class.

Case presentation/demonstration treatment and discussion

Next offering: TBA. Please let us know of your interest in a distance-learning class.

Next offering: TBA. Please let us know of your interest in a distance-learning class.

Avoiding malpractice and complaints; legalities and ethics regarding advertising, fees, billing

With Instructor Anthony Von der Muhll, L.Ac., DAOM, DNBAO, FAIPM

Acupuncture Expert Witness in Malpractice Litigation and Regulatory Investigations

Professional Ethics & Risk Management --Live Webinar with Anthony Von der Muhll

Is your practice safe?

If you're unsure, this Class/E-book is for you!

Topics Include

Live classes and webinars feature instructor-lead peer review/feedback regarding chart notes, and comparison of electronic and on-line documentation systems

Distance learning/self-study, E-book and live class notes feature sample initial functional capacity evaluations and re-evaluation reports for managed care insurance.

Live class features instructor-lead peer review/feedback regarding student reports.

***Please note: For Certification in Acupuncture Orthopedics, either the live class (8 hours/CEUs/PDAs), or the distance-learning class (5 hours CEUs/PDAs) + one live 3-hour clinical case mentorship meeting focused on medical documentation (no CEUs/PDAs) is required.***

Student Ratings and Comments

Workshop Topics:

Who should take this class:

Participants receive:

Next offering: TBA. Please let us know of your interest in a distance-learning class.

With Instructor Anthony Von der Muhll, L.Ac., DAOM, DNBAO, FAIPM

Course Content

Calf, Ankle & Foot Physical Exam

Case presentation/treatment demonstration and discussion

Understanding Chronic Pain: Essential Knowledge

Essential Skills for Working in Integrative Pain Management

Essential History and Physical Exam Skills in Pain Management

AOM Treatment by Tissue and Pattern Identification

Next offering: TBA. Please let us know of your interest in a distance-learning class.

"Is there anything I can do on my own to treat this?

"Should I do this exercise my fitness trainer showed me, even though it hurts?"

"I want to get more cardio and lose weight. Should I run, swim, or bike?"

"When can I go back to my gym workout/yoga class/marathon training?"

How often do we hear our patients ask questions like this? Now you'll have some better answers...

Easy-to-teach exercises can improve clinical outcomes by actively involving patients in self-care, and can complement AOM modalities. Drawing from qi gong, yoga, Pilates, and other techniques, we will discuss exercises for specific injuries to help patients to:

Topics include:

And what's good for our patients is good for us--we'll review self-care exercises and ergonomics for acupuncturists!

General considerations in exercise therapy

Roles of and indications for specific exercise techniques and styles:

Exercise prescription for specific body regions, injuries and pain

Integrating exercise prescription into an acupuncture clinic

Coaching patients on health maintenance through exercise

To get the most out of this class, please wear workout clothes and shoes, and bring the following exercise tools, which you will be able to use later in your clinic. Exercise equipment will not be provided.

Course Goals and Content
On-Demand/Home Study Class