jessephysio

This blog post will be a little different from ones I have written in the past. Today I want to explain the manual therapy system of education as I see it in Canada. This post will hopefully be informative and useful for both other young Canadian therapists and those abroad who have an interest in manual and manipulative therapy.

As I sit at my desk writing this post I am looking at my clock because in about 2 hours time I have to head to downtown Toronto to be a mock patient for the Orthopaedic Division intermediate manual and manipulative therapy practical exam. You will know exactly what that is once you have finished reading this article. I also chose to write this piece because I am currently a student enrolled in the level 3 upper manual therapy course…again, you will know exactly what that is momentarily.

Let’s take a step back and assess why someone would want to do MORE course work after just finishing almost 7 years of post secondary education to become a registered physiotherapist in Canada. I think the answer to that question is a personal one and many people will have different answers. For me it boils down to wanting to do better for my patients. As much as I learned in P.T school, I still feel I lacked the request knowledge to understand the gamut of clinical presentations I was seeing in practice. I know from having placements with manual therapists that have been through the system that their clinical reasoning (problem solving) skills were superior to those who did not do any manual therapy con-ed (just my opinion). So for me, it boils down to learning as much as I can about the field I have chosen to specialize in. When I know more I can treat more and get more people better…this makes for a much for fulfilling career as far as I’m concerned. Because applying ice, stim, and ultrasound to everything that walks in my door just doesn’t do it for me. It also gives me a great sense of specilization…that I have done more to boost my career to the level I want it to be at.

Here is a diagram of the manual therapy system in Canada taken from the ortho division website . It shows a schematic representation of the “level system” and all that needs to be done to navigate through it. I have NOT done the entire system yet as this takes years and I have only been in practice since 2010. However, I have completed the level 1 exam (you can do a course for level 1, but many just choose to do the exam), level 2 upper quadrant course and exam, level 2 lower quadrant course and exam and am now on my level 3 upper quadrant course. The level 2 courses take about 4 months each to complete (you are in class for one full weekend a month for 4 months). Yes, you heard me…an entire Friday, Saturday and Sunday of each month for 4 months is devoted to manual therapy. Each of the 4 weekends deals with a different body area (for example, the first level 3 weekend was dealing with the craniovertebral, mid cervical spine and cervicothoracic junction areas). Not only that but it is essential to study before and after each weekend because the amount of info you are given is overwhelming at times. Personally, I spend on average 30-40 mins/day looking at the notes, reviewing videos online, etc… If I didn’t I would be lost come course time.

Lumbar spine flexion Mobilization

The courses themselves and exams are what are needed to be done to be able to do the practical (hands on) exams. Oh wait, you also need to accumulate a crap load of mentorship hours with a therapist who has already completed the level system to be allowed to sit for the intermediate and practical exams….writing it all out like this really makes it look like an exhausting process haha.

As per the diagram, once you do levels 1-3, gotten mentorship hours, passed the intermediate exam, done levels 4-5, got more mentorship hours, and finally passed the advanced practical exam you get the designation FCAMPT (Fellow of the Canadian Academy of Manipulative Physiotherapists). This is the classical route to take but there is a newer masters program at the University of Western Ontario that fast tracks this processes by giving you level 3-5 and the FCAMPT designation by doing 1 solid year of study…there are pros and cons to this program as what I’ve been told (many of the cons have to do with the huge loss of income incurred by taking the time away from work to complete the in class sessions in London).

To finish this article off I want to give you a glimpse into what exactly is taught on these courses. I have randomly chosen to give some highlights of my last level 3 upper weekend where we talked about the neck. We reviewed:

Subjective assessment of dizziness, cranial nerve symptoms, cord signs, headache, pain etc

Objective assessment of active mobility tests in the neck (including combined contralateral for CV region and ipsilateral coupling for mid cervical region), passive mobility tests for the OA and AA joints, passive accessory testing for the OA, AA, and mid cervical joints (e.g bilateral and unilateral anterior glide at the OA joint), stability testing of the neck using compression, distraction, anterior, posterior lateral and rotational shear—this tests the passive restraint systems in the neck like the alar and transverse ligaments. We learned how to length tension test the suboccipitals (debatable if you can actually isolate these muscles), SCM, lev scap, and all 3 scalene muscles. We talked about treatment techniques in the form of mobilizations for the neck as well as locking techniques and exercise for the deep neck flexors. We also talked about pathologies like thoracic outlet syndrome, spondylosis, nerve entrapment and so on…

Manuals all ortho div students have seen

Overall I love these courses because they really challenge my clinical reasoning skills and force me to critically reflect on my clinical practice. I sometimes fear I have fallen into a “comfort zone” of treatment and do similar techniques for various conditions. This a common trap for therapists and I refuse to be a one trick pony. These courses help me identify issues with my patients I would have never even thought to have looked at prior to taking the courses. Do I agree with everything that they are teaching me? NO! I could do a whole rant on how I really don’t think we can be as specific to a spinal segment (with palpation or grading of mobs) as they want us to be. But hey, you have to take the good with the bad I guess.

Please let me know if I missed anything in this article or if you want any more detailed info on what was said.

Thanks for reading!

Jesse Awenus, P.T