My guide to studying & working abroad Part 1 (For Studies)


Deciding to uproot oneself and moving to a new country can be quite a daunting task, leaving loved ones behind and stepping into the less known. It requires courage and a leap of faith. However, it must be done, to step out of our comfort zone and to challenge ourselves to be able to rely on our own no mater the situation is a great environment for growth and learning. In this blog post I will share some tips that will hopefully make this journey a little less bumpy and ambiguous. In the interest of keeping these blogs short, I will divide them into multiple parts as it’s nearly impossible to keep it short and cover everything. The first two parts are for students planning to study abroad and the following parts will focus on physiotherapy as a career abroad. Here are a list of things to consider-

For higher education –
1. The language barrier- while most of us speak English well and have cracked the IELTS/TOFEL, often the local lingo can be a little different and being able to have seamless confident communication can be a big asset. Try to understand the local lingo and immerse yourself in their language long before you have to move.


2. When looking for other students traveling to the same school as yours (university or college is often called school) start early. Mostly all schools have FB groups of international students. It is an excellent place to start networking. Alternatively, look for contacts or acquaintances that have been to your school before and feel free to contact your international students office to connect you with other students or for any other help.


3. Common sites to look for apartments or roommates in the USA- craigslist and sulekha and kijiji in Canada.


4. Unlike ours, North America has a culture of small talk, use it to break ice with strangers in your class, mostly everyone is open and friendly.

At my school’s very own radio station studio!


5. Following up on the last point, explore and delve into your hobbies and use them to network and build a social circle. One of the biggest challenges international students face living abroad is struggling with having a social life and starting from scratch. Go out and network with students in your college who are not just from your country but locals and other international students as well. It took me a while to figure this out as I was a bit shy initially. Do this early to have a fulfilling school experience. Some good places to start are your school gym, international students office and all the programs they offer, college intra-murals(sports organized by the school for its students played casually but with league and championships games) etc. Universities abroad are like mini townships with a plethora of activities for all kinds of hobbies and interests. I strongly advise you to use them.

Bench press competition as part of intra-murals at my school. (I wasn’t competing if you’re curious)


6. Scholarships and grants- it is great if you can get them, it takes a lot of financial burden off ones shoulders. There are many offered, GA (graduate Assistant), RA (research assistant), TA (teaching assistant). In addition, you may even be able to secure an on-campus job which is the only form of employment offered in USA apart from CPT & OPT (more on that later). In Canada, rules are a little relaxed and you can work off campus with some restrictions on hours.


7. Let’s break this down a little further, a GA is offered to students in graduate programs (what we often refer to as postgraduate or masters). It’s more of a generic scholarship in which you may be given clerical office work by the professor or department that hires you like scheduling data entry in computers, file stacking (what I did) etc, all depends upon your department’s or professor’s requirements so such a scholarship does not have to be in your own department. I encourage you to try different departments in your college as this greatly improves your chances. Students often do not consider looking outside their department, the worse that could happen is a rejection. Smile and move on. A teaching assistant position is generally granted in ones own department and often depends upon your GPA. It involves teaching either undergraduate students some classes or/and helping your professor in your own class. One must demonstrate advanced knowledge in their respective fields to be able to secure this scholarship. You could also find it in different department like maths, biology, physics etc. RA is generally offered if you decide to participate in research as part of your studies and is almost always in your own department and field of study. Each of these may offer either waving your tuition fee partially or fully (unlikely) or paying you hourly or in lump sum.

I’m not nearly done yet, some more points coming in part two of the blog post.

Until then

Pursue excellence

Abhijit Minhas

(BPT, MS, CMP, FMT)

Thoracic Spine Mobility Drills

The thoracic spine (T-Spine) is an interesting part of the body. In recent times it has taken the brunt of the modern sedentary lifestyle of being hunched over on a chair and working on a computer for hours in a day for many months and years. These  modern sedentary lifestyle changes and new work/office setups have had implications on our musculoskeletal system. What is interesting is that the T-Spine itself presents only with a few symptoms like mid back myofascial pain, stiffness, loss of mobility etc.  However, other joints in proximity of the T-Spine are affected adversely due to this. Here is a list of problems we often see in an physiotherapy office that our closely related to an excessively stiff kyphotic T-Spine.

  1. Shoulder impingement- An excessively kyphotic mid back places the scapula in a downwardly rotated, anteriorly tipping and protracted position. This position of the scapula has shown to decrease the sub acromion space in the shoulder when performing overhead activities leading to a common problem we see often; shoulder impingement/pain. Try this little test, try elevating your arm up to the maximum flexion elevation with a straight Tspine and shoulders pulled down and back and then with an excessive hunched over position. Which one feels better and which is worse? See the video below and try it yourself.
  2.  Neck pain- A kyphotic hunched over posture tips the head (weighing about 10-12 lbs approx.) anteriorly and extends our line of sight downwards to the floor. For compensation, we tilt the head backward which increases Cervical lordosis and causes upper cervical spine to go into extension to have a regular straight field of vision. This causes increase tone/tension in the cervical extensors often compressing the greater occipital nerve and other important cervical structures causing symptoms like neck pain, headaches, radiating symptoms etc.
  3. Low back pain- An excessive kyphotic T-Spine pushes the thorax anteriorly and causes compensatory increase in the lumbar lordosis due to increased tension in the lumbar extensors causing pain at the low back. This is the classic presentation of the ‘Lower Crossed Syndrome’.
  4. Breathing- Along with the above compensation, the thorax lifts up due to inability of the abdominal muscles to provide inferior stabilization (lower ribs flaring) decreasing overall chest expansion and causing poor breathing quality and control.

Furthermore,  if you follow the joint-by- joint model of training by Cook and Boyle, you can see that the thoracic spine is meant to be mobile but has a tendency to get stiff.

So, here our some strategies/exercises we can use to maintain general T-Spine mobility. The angles drawn in the video are not exactly accurate and are used for demonstration purpose only-

  1. Bench/chair thoracic spine extension with stick-
  2. T-Spine extension on foam roller
  3. T-Spine windmill rotation
  4. Cat Cow
  5. Four point T-Spine rotation
  6. Threading the needle

 

Closing thoughts, the mid back is meant to provide mobility but tends to get stiff and excessively kyphotic given our contemporary lifestyles. This can open the floodgates to a myriad of musculo-skeletal problems. It is paramount to keep working on its mobility.

Keep limber

Pursue excellence

Abhijit Minhas

(BPT,MS,CMP,FMT)

In The Spotlight- ‘Hip Extension’

Welcome back

As we already know, the problem of glutes amnesia has reached epidemic proportions. Our lifestyle is not like what it used to be. More work gets done sitting on our behinds all day than ever before. Spend too long in sitting  and we slowly start to lose the important movement of hip extension. In this blog post I would like to discuss two conditions that I have often seen in the past which can be directly or indirectly related to loss of hip extension (both lack of active control and loss of ROM). Seen in the general population and often perpetuated in runners. Lets begin-

  1. Low back pain– while the causes for LBP could be endless, we will discuss the role of inhibited glutes and lack of proper hip extension in LBP. If we spend  8+ hours a day sitting on a chair (hip flexion), the glutes will be in an overstretched position and often inhibited. To add to those woes, the hip also gets stuck in a flexion position with classic ilicaus and psoas tightness. Now to maintain a upright posture and to compensate for tightness caused by excessive prolonged hip flexion which would put our trunk in a forward lean,  the back extensors have to work harder to keep us upright. This often manifests as an increased lumbar lordosis (low back curvature). Prolonged time in this position can cause increase in tone of the lumbar erectors and could potentially cause low back pain. I see this often with recreational runners or those who are new to running. During running, if your hip do not go in to enough extension, the back begins to arch and the erectors being part of the posterior chain have to work extra hard. Remember the body is a great compensator but over time this catches up. This, I believe is often one of the common reasons why recreational runners come to see us for low back pain with running.  If you are an athlete or a runner, this is not the best situation for running.  Your glutes have lost their VIP status.  No one likes weak glutes, unacceptable.
  2. Plantar fascitis– I often find people with plantar fascitis have well developed calf muscles. It appears like its ‘calf raises’ day everyday for these folks however on further questioning you may find that they might not have been doing any calf strengthening exercises. If such is the case, I implore you to  check for their active hip extension in walking or running especially during the midstance, heel off and toe off of the stance phase. This is the time when the leg should start to cross back behind the body due to hip extension. This is the primary movement that propels us forward. Now if the body lacks this crucial movement, due to weakness of the glutes max or tightness of the ilio-psoas etc the calf seems to become a more significant driver to push the body forward. Now multiply this a few thousand times a day (even more if you are a runner) over a few weeks, months or years and we have a overworked calf complex. As we all know, the calf exerts a pull on the plantar fascia (remember its a two joint muscle) and that irretates the PF blah blah, we all know this. So improving active hip extension and utilizing the full potential of the glutes is crucial to give the calf a break and in turn might relieve some stress of the PF.

The take home message is simple-  Hip extension is a crucial movement for many daily activities and a lack of which might cause LBP or PF. When treating these conditions, don’t make the mistake of running after the symptoms like I have so often in the past. Here’s a little video to give you an idea of my thought process when analyzing hip extension in running.

 

(PS- this is not the only thing I look for, I’m only focusing on Hip extension here).

You know the drill.

Pursue excellence-

Abhijit Minhas

(BPT,MS,CMP,FMT)

Considering a Physio Career Abroad?

Hola

We are shifting gears for this one. I have received too many questions from students/physios aspiring to pursue Masters/Career in Physiotherapy in the US/Canada etc that I feel I have a duty to oblige.  It has also become extremely difficult to answer the same questions over and over again so I will try to cover some of the most common and pertinent questions in a FAQ format. Here goes-

  1. What are some of the best colleges to pursue masters in sports/ortho/etc physiotherapy in US/Canada?

Most of the colleges in the US offer a 3 years DPT program which is a Doctor of physical therapy program. This is an entry level program which means that this is the minimum degree of education that one must have to practice as a physio. So the DPT is like our BPT program. There is no specific university which offers just sports/ortho/cardio-resp etc training. Depending upon which school (college) one gets admitted into and upon the interests of their professors, there can be some emphasis on some specialization but all in all this program covers the basics that one need to practice physiotherapy safely. To get better in your preferred field will require you to take CME/CEU’s (continuing education), work experience working in your field, internships etc. Also, there are hardly any programs in the US that offer Masters anymore. Canada has Masters in physiotherapy but that is an entry level program as well and will mostly cover topics we have studied in BPT already. The Canadian masters is a two year program

2. Is Masters in exercise physiology/Kinesiology (KIN) similar to a Masters in physiotherapy?

No, its a different field and a different profession. There is a lot of overlap in terms of what we learn. However, we have a broader scope of practice than a kinisiologist/ exercise physiologist. While, passing the NPTE exam in the US and the PCE in Canada is a mandatory requirement to practice as a physio; to practice as a KIN/ exe. physiologist one does not require to pass a national exam. Some gold standard certifications which might give one an edge are ACSM, ACE, NASM, PES etc. An exception here is the CSCS which is required to practice as a Strength and Conditioning Specialist. Please refer to my previous blog (Masters in the USA- Are you confused? Part 1) and MASTERS IN THE USA- Are you confused? Part 2 to know more about these fields/programs.

3. Can I practice as a physio after a Masters in exercise physiology degree?

You could take a masters in fine arts or business degree but as long as you have a Bachelors in Physiotherapy and pass the board exam you can practice as a physio.  YOUR MASTERS HAS NO INFLUENCE ON YOUR ABILITY TO PRACTICE AS A PHYSIOTHERAPIST (in Canada). However, recently US has changed its requirements to practice as a Physical therapist. Please check with FSBPT (Here) and NYSED (Here) for more details.

4. Is the NPTE/PCE very difficult?

While I haven’t given the PCE yet, it is somewhat based on the NPTE from what I hear. Yes they both are difficult but not impossible. Many international physios have passed this test. It requires a lot of hard work and dedication but its doable. The PCE has two parts, written and practical. The written component has 200 MCQ’s passing which one can appear for the practical. The NPTE is a 250 MCQ format exam. The hard part here for us is getting tested in a MCQ format rather than a essay format that we are used to.

5. What is the average salary of a physio in the US/Canada?

It depends. On a lot of things. Ones preferred practice setting, overall work experience,  North American work experience, language proficiency, interpersonal skills,  certifications after college, location, immigration status(unfortunately) etc. Pediatric physios working with children with disabilities in schools are  most likely compensated more than an outpatient physio. Depending upon where you practice salaries will change. Generally speaking, Physios in NYC have higher salaries than in physios in Idaho or West Virginia. Or in Canada, Physios in Alberta might make more than physios in Quebec. On the flip side if you take up a contract in the North Western territories up north in Canada where it gets very cold, you most likely have a higher salary than a physio working in Toronto. But to give you a rough estimate, a new grad physio or a new internationally trained physio can expect a starting salary of $32/hr as a starting point in both US/Canada in outpatient setting. Again, these number vary depending upon all the factors I mentioned above. I have added some links here to help you navigate this topic. Find them HereHere and Here. Again, at the cost of sounding repetitive, these are some estimates, use them as a guide.

I’d love to hear your feedback on this one. If I get a good response and more questions, Ill make this into a series of blog post. So send me your questions here.

In the mean time..

Pursue excellence-

Abhijit Minhas

(BPT,MS,CMP,FMT)