Here’s the latest edition. You know the drill.
Until next Tuesday or a new post
Abhijit Minhas PT
(BPT, MS, CMP, FMT)
Here’s the latest edition. You know the drill.
Until next Tuesday or a new post
Abhijit Minhas PT
(BPT, MS, CMP, FMT)
My last two blogs focused on things to consider when moving abroad for masters. You can find it HERE and HERE. This blog post will feature things to consider when moving abroad to start practicing as a licensed physiotherapist. When I say abroad, I am referring to the countries I have worked in – The US and Canada. Ok, here we go-
I have a few more points coming in the final part 4 of this blog post. Stay tuned and always
(BPT, MS, CMP, FMT)
Continuing from where I left off in the last blog post here are some things to know-
8. If you are not able to secure a scholarship don’t get disheartened. There are a few other options like on campus jobs. They won’t cover your finances like a GA,TA or a RA, but hey, every bit counts right. In North American, this could be working in your college cafeteria, working in the gym reception or the recreation center of your university, library, student help center or coaching center. One gets paid on an hourly basis and we are permitted to work 20 hours when school is in session and 40 hours during summer break, end of semester break etc. Working off campus is illegal in the USA and if caught you could be looking at deportation. I’ll advise against it. Canada is more relaxed and allows off campus jobs with similar restrictions on working hours as the US. This could be one of the important factors to consider when deciding where you would like to pursue your masters.
9. Back in 2011, on campus jobs were minimum wage jobs fetching $7.25/hr. This might have changed now as the minimum wage has raised. Some on campus jobs where you tutor other undergraduate students in subjects like maths, sciences etc can be a little higher paying depending upon what university one goes to.
10. CPT (curricular practical training)- is temporary employment authorization off campus that is offered in US universities which could be from 6-12 months while you are still studying in the program. This employment must be in the field of study. Consider employment under CPT as a regular job, you give the interview, you negotiate your salary. You are looking at much higher salaries (especially in our profession) compared to on-campus jobs but remember that one must have a physical therapy license to even consider this option. Also, most schools won’t offer them in the first or second semester. Depends on their policy, so don’t count on it when you first start school.
11. OPT (optional practical training)- is a temporary employment authorization offered mostly at the end of one’s studies (can be offered after one year of completion of studies as well). You must apply for it a few months before graduation, do not forgot to apply. If you do not, you will miss this very important period to work and gain some North American experience. It’s also a buffer period or a transition period between being a F1 student to getting a H1B if that’s the route you wish to choose. It is offered for 1 year and if your course is a STEM program (science, technology, engineering and mathematics) you are eligible to get a 17 month extension on your already 1 year OPT period. It’s called OPT extension. I know that exercise science falls under it ( I don’t think a Masters in physical therapy does, but I’m not sure about all schools) but make sure you ask your school before assuming. Needless to say, to work under this period as a physiotherapist/physical therapist you will still need your license.
12. Masters is physical therapy is not a very common course offered in the US anyways (very few schools were offering it in 2011, I’m not sure about it now). This program has slowly been outdated and replaced with a 3 year doctorate of physical therapy (DPT) program in most of the schools across the USA. Basically it’s the same as our BPT. For specialization in particular fields like orthopedics, sports, geriatric etc, there are many residencies and other courses offered by APTA but generally not a full time 2 year university course. (I did masters in exercise science. To know more about it follow my previous blog HERE). In Canada, there is no bachelors in physiotherapy anymore. Here, bachelors could be in psychology major, exercise science etc where you gain credits in anatomy, physiology etc and then apply for a masters in physiotherapy which is a 2 year program (similar to our bachelors). Again, just like the US, to pursue specialization in different fields, there are smaller courses and workshops but no full time post graduate program.
13. Some common questions that I get asked often are ‘what are credits?’. Consider credits as a form of unit. Every subject that one takes during a semester has a certain number of credits assigned to it (generally 3-4). To graduate one must complete a set amount of credits. To give you an example, for my program, I needed 36 credits to graduate from a masters programs and every subject was assigned 3-4 credits. Most universities will present tuition fee in terms of fee per credit. You can do the maths and calculate your full course fee.
14. Finally, remember that unlike our colleges and universities where the curriculum is preset for us, in North American universities you choose what courses you would like to take. There are core courses which are mandatory and then there are a bunch of elective courses to choose from. For the most part, you choose what subjects or courses interest you and choose which semester you plan to take it. Of course, your advisor will be there to guide you through the process.
Hopefully this information will help you to make a better informed decision when deciding what country and program you wish to pursue.
Next blog post will focus on physiotherapy as a career abroad and thing you should know before making a decision.
(BPT, MS, CMP, FMT)
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.
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.
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.
(BPT, MS, CMP, FMT)
This blog post will be a quick one. I often utilize the upper limb tension tests (ULTT) to assess patients with pain and other radicular symptoms going down the arm. I check first the unaffected side and then the affected side to compare asymmetries and also use it for mobilization of nerve roots. However, as a reoccuring theme I have been aggressive with my tension tests in the past just like so many other techniques and have had less than favourable results. So in accordance with my ‘less is more’ thought process (in terms of pressure/force/aggressivness) I have made some tweaks in how I perform my nerve mobilizations. This is especially true for ULTT and LLTT tests and mobs because these are provocative manuvers and ‘I like lightning bolts running down my arms and legs’ said NO ONE EVER. Today we will discuss Median Nerve Neurodynamics.
Components of Median nerve neurodynamics involve-
Here is a video demonstration of the test with some variations.
Please note that in one of the mob variation with elbow movements, I do not press the wrist down into complete extension. That is because prior testing of this variation of nerve mobilization was very threat inducing and provocative and I didn’t want to be very aggressive.
What are your thoughts? Do you have some tweaks on hand placement, body positioning, force applied or different variations? I’d love to hear it.
In the next blog post we will discuss some home exercise programs (HEP) for self mobilization. Happy flossing (but go a little easy maybe). Until next time.
(BPT, MS, CMP, FMT)
Part deux of this blog is not really a course review but my thought on taking the Certified Mulligan Practitioner exam. To begin, I’ll say this, you don’t need to be a Certified Mulligan Practitioner (CMP) to be a good therapist. I know many physios who are great clinicians but haven’t taken the CMP exam. The Certified Mulligan Practitioner exam is a test to check your competency in Mulligan concept principles and application of techniques passing which you get the title CMP. Like I mentioned in the last blog, the Mulligan concept does not cover a whole lot on assessment/diagnosis. So the testing skips that part too.
What to expect in the test-
I gave the test back in 2010 and back then the test had two components. I have heard that the format has not changed a whole lot but don’t quote me on this.
Written Component- consisted of 50 MCQ’s. The Multiple choice questions which seemed tricky and often felt like they had more than one correct answer (they did not) was the easier part of the exam in my opinion.
The practical component- I believe was demonstration of 10-15 techniques (approx). Successfully passing the exam requires the test taker to be competent in each and every technique of the book and one would be asked to demonstrate any random 10-15 techniques covering all bases. This included everything- NAG’S, SNAG’S, MWM’S, SMWAM, SMWLM, headache SNAG’S, belt techniques, BLR, taping techniques etc. The practical component was conducted by two Mulligan Concept Teachers Association (MCTA) members; in our case one local from India and one from Australia.
Passing requires around 80% scores (approx) and attention to detail is important making sure one applies all the 7 principles of the concept when performing the techniques.
Is it worth it?
I can see why this question would cross someone’s mind. After all, one doesn’t need the title to practice in the profession or even to apply these techniques. You could just do the workshop/seminar course and still apply the concepts in your clinical practice. However, in my opinion it is worth it. Going through the extra grind has its advantages. I’ll give you not one but…. two!!
Hope this information helps. More course reviews to follow in some upcoming blogs. Lets keep the dialogue going. Until next time.
This is my first blog post review on a workshop/course so it only makes sense that I write about one of the most pivotal workshops early on in my career. Drum roll, ‘The Mulligan Concept’.
Before we begin, I would like to take you’ll on a little flash back in history back to 2009. I was in my 4th and final year and was about to graduate with my bachelors in physiotherapy degree. Needless to say, I was still trying to put all the pieces of the puzzle together (almost a decade later and I still am!) and quite frankly struggling at it. By now I was expected to be able to figure out what was going on with my patients. I could follow the SOAP procedure to get all the information like I was taught but was unable to put it all together. To make matters worse, the few things that I had truly mastered at the end of my 4 years was how to make near perfect loopy circles on the body while giving ultrasound and mastered not to electrocute patients on modalities (that’s right, a slight exaggeration). Modalities were the biggest arsenal in my ‘physio toolkit’ along with some very basic home exercises and frankly it did barely something if anything to my patients pain scores or any other outcomes. It didn’t matter if the machines now had digital panels instead of the knobs, they were all a let down. Maybe I relied on modalities too much (In fact now I know that really was the case). But what else was out there? I had not even started my internship and the future didn’t look so promising. I was looking for a way out. And then…
Enter the Mulligan Concept
This 8 day workshop was everything I need at that time (almost everything). It was a real game changer. Taught by a dynamic and engaging teacher who was also a great role model for a young physio student, the concepts looked pretty straightforward and gave me new hope. I began using the techniques right away and as many physios have reported alike, the results were just like how Brian Mulligan would describe it instantaneous and almost miraculous.
Before we proceed, full disclosure, I am a Certified Mulligan Practitioner and I am biased to this approach in physiotherapy. But I’m even more biased at presenting accurate information through my experience in this blog. So here is my take on what I liked and disliked in this concept-
There is no ugly.
To sum it all up I think the Mulligan Concept has some shortcomings but is all in all a great concept. It definetly changed the trajectory of my professional career and taught me a lot. I will endorse it to anyone who cares to hear my opinion. Its a good concept to be familiar with.
Now would you want to go the extra distance to get recoganised in the system as a Certified Mulligan Practitioner (CMP), go through the pains of going through a written and practical exams like I did? More on that in part two of the blog post series. Until then
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-
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.
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-
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 Here, Here 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..
This is going to be a short one. As indicated before on my social media, this one is on the feet. Foot examination is a big part of my assessment with patients presenting with lower extremity pain and often back pain. Of the many dysfunctions of the feet that could cause pain anywhere along the lower extremity, a pronated foot often steals the lime light. While there are definitely problems that can be associated with excessively pronated feet and has been well established in the literature, I must point out that the word ‘excessive’ is important here. When I first started looking at the body not just as individual parts but as a unit together, the idea of regional interdependence was a game changer.
However, I was quick to jump on the bandwagon of blaming pronation for everything- shin splints, tibial stress fractures, ACL injuries, hip issues, global warming, oil crises (a bit too much, I know. Just my attempt to keep this as light reading). Remember that pronation is a regular part of the gait cycle during the suspension phase and also is a normal physiogical movement of the body. It is really the ‘excessive’ pronation and medial arch collapse that we should be worried about without demonizing foot pronation.
Apart from generally eyeballing movements for foot positioning during different movements like running, walking, squatting etc I like the Navicular drop test to assess ‘over pronation’/ medial arch collapse. Here’s a video of how I perform it.
If the difference between the two points is >10mm then the test is considered positive.
I’m keen to read your thought on this subject. Do you often use this test? Any other tests you like to use in your assessment? Would you like that featured on this blog? Feel free to share your thoughts.
For those of you who are wondering what an excessively pronated foot has got to do with other lower leg problems (not you of course, you know this all to well), its might be useful to understand how problems at the feet might cause problems upstream at other joints, its called ‘regional interdependence’ and this is just one example. Understanding this is paramount. More on this in the next blog. Until next time
Abhijit Minhas PT
(BPT, MS, CMP, FMT)