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Efferent Essentials - Techniques for Peripheral and Central Lesions

Presented by: Dr. Norman Hoffman

This class is for practitioners looking to take their examination and treatment skills to the next level by focusing on the information gleaned from the efferent/motor system.  This understanding leads to higher levels of performance and interpretation, leading to improved patient assessments and outcomes.   Clinicians will learn how to leverage the efferent system in working with peripheral entrapment disorders, axial tone problems and their concomitants, disc lesions, discovering the longitudinal level of the lesion, cortical strategies, gait patterning, brain-based and manual treatment strategies, and more. This is a clinical techniques program, so be prepared to move and learn-by-doing. 

This program gives clarity around the specificity of treatment by leveraging a new exam flow that can be performed in 5 minutes, from head to toe, not previously taught in ReceptorBased Essentials or Pain Reset. 

Easy to apply – At first, learning the breadth of the functional neurology paradigm can be daunting.  Efferent Essentials solves this by focusing on the efferent system and how it can be leveraged clinically.

Fast – Learn an exam flow of the efferent system that can be done in just a few minutes in the office, on any patient. Quickly know where to focus your treatments, i.e., brain, nerve root, muscle, etc. 

Practical – This program is a hands-on, learn-by-doing program where you can learn the skills you need during the three days of training and apply them immediately in clinical practice.  No fancy euipqment needed. Just you, your hands, and what you will learn throughout the training is all that is needed.

Neurological Model in Clinical Practice – Efferent Essentials show you how efficient a neurological model can be to implement in practice. Clinicians find that by adding a neurological lens to their practice, they have more options and opportunities to succeed with their patients. 

Hone Your Skills in Assessment and Treatment

For those who have taken the Carrick Institute’s foundational programs, this is a perfect next step as it builds upon the clinician’s skills in treatment and diagnosis of the level of neurological decompensation in your patients.

Efferent information from the central nervous system is one of the most valuable tools for determining the level of the lesion in complex clinical cases. This hands-on intensive course will give participants the skills to understand, perform, and interpret a neuro exam flow that can be easily implemented in clinical practice.  Incorporate elements from your history, observations, and examination to know what exam procedures to perform and master your understanding of the results.  This is not simply the performance of a series of memorized tests but a true understanding of why each test is important, what it means, and what to do about it. 

Scholars Will Learn

  • Case history skills that lead to an effective motor examination
  • Protocol for observation of motor deficits
  • Neuro exam patterns associated with
    • patterns of prefrontal, frontal, temporal, parietal, mesencephalic, pontine, vagal, and cerebellar motor changes
    • peripheral nerve entrapments
    • cervical nerve roots
    • lumbosacral nerve roots
    • subclinical myelopathy
  • Treatment options for each of these presentations
  • Cross-correlation with other exam findings such as eye movements and sensory exams
  • and more!

After the program, you will know –

  • what is causing your patient’s problem
  • which area of their nervous system may require a brain-based approach
  • when NOT to use certain manual therapies
  • how to more quickly ascertain whether your treatment plan is appropriate for that specific patient
  • quickly find out which therapies TO LEVERAGE
  • efficiently help your patients, so you don’t bog down your busy practice

Detailed Course Outline

Chapter 1 – Functional Neurology of the Efferent System / Manual Muscle Testing

  • Renshaw cells
  • Recurrent Inhibition
  • Eccentric contraction vs concentric
  • contraction for testing motor output
  • Descending control of motor output

Chapter 2 – Overcoming Challenges

  • Reliability
  • Force curves
  • Objective measurement tools
  • Measuring Tone vs Strength
  • Grading Systems

Chapter 3 Neurology of Muscle Tone

  • Corticospinal Excitability
  • Motor output
  • Muscle spindle and GTO response
  • Spinal interneurons
  • Dorsal Columns
  • Nucleus gracilis and cuneatus
  • Spino-olivary tract
  • Spino-cerebellar tract
  • PMRF
  • Vestibular nuclei
  • Limbic system
  • Ruffini corpuscles

Chapter 4 – Upper Extremity: Shoulder/Elbow – Assessments, Clinical Implicaions and Treatment

  • Deltoid
  • Levator Scapulae
  • Rhomboids
  • Supraspinatus
  • Biceps Brachii
  • Brachialis
  • Pectoralis Major – Sternal and Clavicular Divisions
  • Teres Minor
  • Infraspinatus
  • Subscapularis
  • Serratus anticus
  • Latissimus Dorsi
  • Teres Major

Chapter 5 – Upper Extremity: Wrist/Hand – Assessments, Clinical Implications and Treatment

  • Opponens Pollicis
  • Opponens Digiti Minimi
  • Extensor Pollicis
  • Wrist Extensors
  • Wrist Flexors
  • Finger Extensors
  • Dorsal Interossei
  • Abductor Pollicis Longus and Brevis
  • Flexor Pollicis Brevis
  • Flexor Digitorum

Chapter 6 Upper Extremity: Nerve Impingement Syndromes

  • Suprascapular Nerve Entrapment
  • Median Nerve Entrapment
    • Supracondylar
    • Pronator teres
    • Carpal Tunnel
  • Ulnar Nerve Entrapment
    • Intramuscular Septum
    • Arcade of Struthers
    • Cubital Tunnel
    • Forearm Flexors
  • Radial Nerve Entrapment
    • Triangular Space
    • Spiral Groove
    • Lateral Intermuscular Septum
  • Rule of Nine
  • Axillary Nerve Entrapment
  • Long Thoracic Nerve Entrapment
  • Modified Tinel Tap Testing
  • Thoracic Outlet Syndrome
    • Vascular
    • Neurogenic
  • 4 Treatment Strategies – Cervical Disc Syndrome

Chapter 7 – Axial Tone and the Central Nervous System

  • Major Influences on Axial Tone
  • Case Examples
    • Concussion
    • Neurodevelopmental Disorders
    • Immune System Disorders
    • Anxiety Symptoms
    • Status migrainosus
    • Visual Snow
  • Assessment and Treatment Model

Chapter 8 – Discovering the Logintidual Level of the Lesion

  • Corticospinal Excitability
  • The Pons and the Vestibulospinal Tract (VST)
    • Manual Muscle Testing and Interpretation
    • Comparison with Posturography
    • Dual Tasking The VST
  • Diaschesis, Transneuronal Degeneration and Dedifferentiation
    • Clinical Presentation
  • The Mesencephalon and the Rubrospinal Tract
    • Manual Muscle Testing and Interpretation
    • Dual Tasking the Mesencephalon
  • The Corticoreticulospinal Tract (CReST)
    • Manual Muscle Testing and Interpretation
    • Dual Tasking the Cerebral Cortex
      • Paleocortex
      • Prefrontal Cortex
      • Temporal Lobe
      • Parietal Lobe
      • Limbic Lobe
      • Colliculo-thalamic Loops
      • Medulla Oblongata
    • Interstitiospinal and tectospinal Tracts (IST and TST)
      • Manual Muscle Testing and Interpretation
      • Dual Tasking the Interstitial Nucleus of Cajal and the Cervico-ocularresponses
  • Windup Phenomenon, Basal Ganglia and Manual Muscle Testing

Chapter 9 – Functional Neurology Paradigm Interventions

  • Subclinical Myelopathy
  • Clinical Presentation
  • Assessment and Treatment
  • Pontine strategies
  • Mesencephalic strategies
  • Cerebellar strategies
  • Frontal and Prefrontal Strategies
  • Temporal strategies
  • Parietal strategies
  • Limbic strategies
  • Medullary strategies
  • Basal Ganglionic Strategies

Chapter 10 – Lower Extremity Hips – Assessments, Clinical Implications and Treatment

  • Psoas
  • Iliacus
  • Thigh Adductors
  • Transversus Abdominus
  • Sartorius
  • Tensor Fascia Lata
  • Gluteus Medius
  • Gluteus Maximus
  • Piriformis
  • Rectus Femoris

Chapter 11 – Lower Extremity: Knees – Assessments, Clinical Implications and Treatment

  • Vastus Medialis Obliquus
  • Vastus Lateralis
  • Semimembranosus / Semitendinosus

Chapter 12 – Lower Extremity: Ankles – Assessments, Clinical Implications and Treatments

  • Tibialis Anterior
  • Tibialis Posterior
  • Gastrocnemius
  • Soleus
  • Peroneus Longus and Brevis
  • Extensor Hallicus Longus and Brevis

Chapter 13 – Lower Extremity: Nerve Impingement Syndromes

  • Piriformis Syndrome
    • Comparison to Lumbar Root Lesion
  • Common Peroneal Nerve
  • Superficial Peroneal Nerve
  • Tarsal Tunnel Syndrome
  • Morton’s Neuroma
  • 3 Treatment Strategies – Lumbar Disc Syndrome

Chapter 14 – Gait Pattern Analysis

  • Propulsive Gait
  • Scissor Gait
  • Spastic Gait
  • Steppage Gait
  • Waddling Gait
  • Weakness Gait Patterns
    • Gluteus medius weakness 
    • Tibialis anterior weakness 
    • Quadriceps weakness
    • Gluteus Maximus weakness
    • Gastrocnemius weakness

Included in Your Tuition


General Tuition: $999 


  • 25 hours of training with Dr. Norman Hoffman
  • All-access to the digital recording of the class
  • Any future updates to the course videos or other materials
  • Re-attendance*
  • 25 Neurology Hours towards the ACFN (American College of Functional Neurology) & ACNB (American Chiropractic Neurology Board) with each module
  • Access to the flipped classroom with lifetime updates
  • 3 months of unlimited access to Medline upon completion of the module

*Scholars will receive CEU & neurology hours upon their first completion of the module. Any re-attendance is considered an audit.  Scholars must maintain an active account to receive benefits. 

Re-attendance policy: Scholars who have registered and completed a course after December 2019 have the ability to re-attend the course with no additional fee. When re-attending a course, the scholar will not receive continuing education credits and will receive an audit. Carrick Institute is not responsible for providing new materials for class audits, including but not limited to manuals, shirts, equipment, etc. If manuals have been updated since the original attendance date, the updated materials will be available via PDF on the scholar’s online portal. If the scholar would like to purchase a new paper manual, they may do so before the course start date.

To view full Terms & Conditions, click here.

For more information on CE/CME eligibility, visit

Program Dates

Muscle Testing in Functional Neurology - Advanced Skills for DDX and Treatment Self Paced Learning:

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