My guide to studying & working abroad Part 2 (For studies)

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.

LIU blackbird basketball game underway at the WRAC (recreation center). A great place to not just play and watch sports but also a good place to look for on campus jobs.


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.

Good luck


Pursue excellence

Abhijit Minhas

(BPT, MS, CMP, FMT)

My Course Review 2- The Certified Mulligan Practitioner Exam

Greetings

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!!

  • Early on in my career as a new grad, I always used my CMP credentials to bag better than average job opportunities and a little higher than average salary  that a new physio would expect. To the new graduates starting their career in physiotherapy I’d say this, physio school will teach you the basics and how not to harm a patient but some of the curriculum is not up to date with the latest in the field and taking certifications will improve your overall clinical skills. It will also make you a more desirable candidate in the job market. Good physiotherapy offices value continuing education certifications and titles. CMP is a good title to have.
  •  On becoming a CMP, you become part of the network of Certified Mulligan Practitioners. The database for a full list of CMP’s across the world can be found on the Mulligan website here.. This directory can sometimes be a good source of referrals for new patients/clients. I have had other mulligan practitioners refer patients who were around my practice and I have also had patients use this directory to find me directly. It can be quite a useful tool.

149923_157425290968325_3827797_n
It is worth it!

Hope this information helps. More course reviews to follow in some upcoming blogs. Lets keep the dialogue going. Until next time.

Pursue excellence-

Abhijit Minhas

(BPT,MS,CMP,FMT)

My Course Review 1- The Mulligan Concept

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-

The Good

  • The 7 general principles of the Mulligan concept apply to every technique on every joint in the body. Now there are many techniques (NAG’s,Reverse NAG’S, SNAGS, MWM’s, SMWAM’s, SMWLM’s, belt assisted MWM’s etc) and even more joints in the body. However, there are no exceptions to the rule.
  • When a particular glide is applied correctly and it works good to reduce pain with a certain movement, it works just great.
  • If you follow the general rules of the concept, chances of aggravating patients symptoms are slim. All movements must be pain free or should reduce pain with every repetetion.
  • The concept focuses on function and I’m a big fan of that. If squatting hurts, your glides will preferably be in squatting, if its walking that gives your patients some grief, the glide is applied in walking (a little difficult) and so on. I’m not a big fan of prolonged passive treatments on a bed if the chief complain is doing some activities. Weight bearing and movement is not just encouraged, its a principle.
  • Results are generally quick and instantenous.

The Bad-

  • Most of the techniques are joint biased. It does not address soft tissue work that might be needed on up-regulated, knotted muscles etc. (Brian Mulligan does mention that his techniques should be applied with other interventions). So this course will not address too much of your ‘manual therapy for soft tissue’ needs.
  • In my mind the biggest short coming in the concept is the lack of understanding of why it works so well when it does. It is based upon the older mal alignment, ‘positional fault’ leading to pain model of explanation which we now know is not the best model to explain something as complex as pain. We have better understanding of these concepts now. I’m not sure if the Mulligan Concept Teachers Association (MCTA) has now changed their explanation/narrative in light of the new pain science research coming out. There is still some ambiguity there.
  • Unlike some other concepts like the MDT, Maitland etc that focus on the assessment part as well as intervention the Mulligan Concept is more of a treatment system. It won’t do a whole lot in terms of adding to your diagnosis or assessment skills.
  • Some techniques are too specific and in my humble opinion too subjective from physio to physio. Here’s an example, some glides like the rotational MWM’s require the practitioner to isolate say the L/R transverse process of the C6 vertebral body. This gets even harder by the time we get to the lumbar spine as now we cannot use our digits but gotta use the ulnar border of the hand on specific spinal and transverse processes. Try this with a bunch of your physio friends and see if you can agree upon your palpation skills every time on every segment of the spine. I struggle with some of these palpatory methods that need us to be highly specific and have such subjectivity. Another example is the PA mobilization (sorry not Mulligan but I had to throw it in there). I have found  movement based observatory method more quantifiable.
  • I am not the biggest fan of the Mulligan Taping techniques. Some of the taping techniques are supposed to ‘hold’ the joint in the correct position. I don’t think a tape on the skin can keep for example a shoulder in a postero-lateral position and keep it from falling back in a ‘mal-position’. There are other examples too and I can state a few but I wont. You get the point. There are better taping courses out there with better explanation of why we belief taping works. Also, baring a few conditions, I like tape that permits motion not restrict it.

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

Pursue excellence-

Abhijit Minhas

(BPT,MS,CMP,FMT)