Lets face it, going through the community based level system run through the Orthopaedic Division or through either Western’s or the newly formed McMaster masters program in Manual and Manipulative Therapy is tough. These are structured programs that require many months of study, practice, exams, and mentorship. Let’s also not forget all the associated course/tuition fees and lost income from time away from work to finish these programs. I finished my advanced diploma in 2015 and it took me about 5 years to get through it all. I recall having to say no to many weekend getaways during the summer of my advanced exam as I would be at home hunched over my desk studying anatomy, biomechanics, pathology, and everything else the people reading this know all too well about. It was quite the onerous process to say the least.
So why do we do this to ourselves? What posses a physiotherapist to take on this extra burden after already completing 6+ years of university study to become a registered physiotherapist. While I’m sure this answer differs for many, I think it comes down to a few key concepts. First off, physiotherapists by nature have a thirst for knowledge and betterment. I know this because year after year the Allied Health Professional Fund (AHPF) in Ontario consistently states that we as physiotherapists use up our funding much quicker than every other listed profession combined! (We sure do like our continuing education). We strive to do better for our patients and figure out exactly why we fail to help a portion of the patients who seek us out. Second, physiotherapists love a good challenge. Despite all our bitching and moaning about the process of becoming an FCAMPT, we enjoy the ride and the community it builds for us both professionally and socially. I can’t tell you how many amazing physiotherapists I wouldn’t have otherwise known had I not done all my levels. The professional networking at these courses cannot be understated.
Other reasons for gaining fellowship may include increased status within the profession, monetary gain from clinics/bosses who provide additional payment for course completion, and for self satisfaction. I’m sure people reading this have their own reasons for taking a level course or doing another masters program.
I would be remiss if I said everything I learned and studied was based on solid evidence and I would be doing a disservice to my skeptical nature if I didn’t have grievances on how the program is taught. While this article isn’t a commentary on the current state of manual therapy education in Canada, I do think it’s prudent to point out that many of the pathobiomechanical models that are routinely taught within the CAMPT program don’t follow suit with emerging evidence. I distinctly recall being made to feel inept when I couldn’t feel thoracic spine passive intervertebral motion (PIVM) as well as the person instructing me. If I’m to be honest, I recall leaving class some days feeling more stupid and incapable then when I entered. It was later on in my career that I realized that was simply not the case and that there have been repeated studies concluding that identifying lesions by motion palpation are not reliable (Huijbregts et al 2002, Nyberg et al 2013, Seffinger at al 2004). I began to worry that the physiotherapist down the street from me would be better able to help a patient in pain because they were able to be more specific in their treatment selection and delivery then me. Fortunately, I realized this was also not the case. There are now a number of studies showing similar benefits among patients receiving “therapist selected” and “randomly selected” mobilizations or manipulations. Both groups seem to show equal short-term improvements as long as they receive any form of manual intervention (Donaldson et al 2016, de Oliveira et al 2013, Chiradejnant et al 2003, Aquino et al 2009). I learned through many hours of reading research that manual therapies can be very effective for nociception reduction, but the exact mechanism for this is till up for debate. If you can keep these ideas in mind as you go through the CAMPT program, I think you will enjoy it much more.
It may seem like I’m saying that becoming an FCAMPT was a waste of time, but that couldn’t be further from the truth. The program I was taught gave me a much more solid foundation in differential diagnosis, screening for red flags and understanding anatomy at a much deeper level. I feel better off for having been through the system and I am glad I stuck through it. There are rumblings that when the new manuals come out next year there will be less emphasis on motion palpation and biomechanics and more emphasis on neuroscience education and a more current model explaining the possible reasons why our hands can help make people feel so much better. I welcome these changes and hope to see more made in the future to keep our program relevant in light of all the emerging evidence surrounding manual therapy. I am a proud FCAMPT and I encourage anyone with any questions about it to contact me. I would be happy to help in any way that I can.
Jesse Awenus B.A Hons (Kin), MSc.PT, Dip.Manip.PT, FCAMPT
Registered Physiotherapist
http://www.JessePhysio.com
References:
Aquino RL, Caires PM, Furtado FC,. Applying Joint Mobilization at Different Cervical Vertebral Levels does not Influence Immediate Pain Reduction in Patients with Chronic Neck Pain: A Randomized Clinical Trial. J Man Manip Ther. 2009 Apr 1;17(2):95–100.
Chiradejnant A, Maher CG, Latimer J, Stepkovitch N. Efficacy of “therapistselected” versus “randomly selected” mobilisation techniques for the treatment of low back pain: a randomised controlled trial. Aust J Physiother. 2003;49(4):233- 41.
De Oliveira RF, Liebano RE, Costa LC, Rissato LL, Costa LO. Immediate effects of region-specific and non-region-specific spinal manipulative therapy in patients with chronic low back pain: a randomized controlled trial. Phys Ther. 2013; 93: 748– 756
Donaldson M, Petersen S, , et al A Prescriptively Selected Non-Thrust Manipulation Versus a Therapist Selected Non-Thrust Manipulation for Treatment of Individuals With Low Back Pain: A Randomized Clinical Trial. J Orthop Sports Phys Ther. 2016 Mar 8:1-29.
Huijbregts PA. Spinal Motion Palpation: A Review of Reliability Studies. J Man Manip Ther. 2002 Jan1;10(1):24–39.
Nyberg RE, Russell Smith A. The science of spinal motion palpation: a review and update with implications for assessment and intervention. J Man Manip Ther. 2013 Aug;21(3):160–7.
Seffinger MA, Najm WI, Mishra SI, Adams A, Dickerson VM, Murphy LS, et al. Reliability of spinal palpation for diagnosis of back and neck pain: a systematic review of the literature. Spine. 2004 Oct 1;29(19):E413–425.
jessephysio 
Hi Jesse,
Great post. Did you go through the Western program or the level system?
Brian
I did the level system. Thanks for reading!
Please repost on my blog! I’ll schedule
Dr. Erson Religioso III DPT, MS, MTC, CertMDT, CFC, CSCS, FMS, FMT, FAAOMPT Fellowship trained in Orthopaedic Manual Physical Therapy Modern Manual Therapy The EDGE Mobility System Updoc Media NxtGen PT
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I cruise on over to your blog often Jesse as I like the content. But I must say, I have much less confidence than you that the system is going to change much. Way too many deeply entrenched “believers” and ego protectionists for that system to suss out all the indefensible patho-anatomical (palpatory pareidolia) anytime soon.
Let’s hope the program changes but as it stands now…it’s completely antiquated and unlike you, I see little value in it.
Hi GB,
Thanks for reading the article and commenting. I believe that the Ortho Div will ultimately have no choice but to change. IFOMPT will soon make it mandatory that all accredited programs include a research component to be eligible for graduation. In Ontario, Western U and McMaster U both have IFOMPT accredited masters degrees that include a large research component. This will force the OD to change. There are too many savvy therapists that are questioning the antiquated notions on motion palpation and the mechanisms behind manual therapy. Believe me, I am NOT the only physio I know that questions what they were taught. I’m just the only one I know with my own website (soapbox) to talk about it publicly.
With all that said, I stand by my original post. I am a better physio for having done the program. We learned SO little about true differential diagnosis in the MSK world in physio school. I feel much more confident and capable that I can suss out pathology not amendable to what I can treat as a physio and refer to the appropriate provider. Plus, having the hands on skills to apply a good, crisp manipulation has been quite helpful in my practice. There are days at a time I don’t manipulate anyone, but when it’s warranted, It can be a great tool to have at my disposal.
Have you done level courses? Have we met?
Thanks for stopping by!
Really appreciate your insights Jesse. I guess I view things from a more skeptical vantage point and this is what I mean by that:
From my perspective, I actually find the program to be a barrier to true advancement within our profession here in Canada. I know that almost all of the new graduates at my alma mater are essentially convinced that the program is a requirement and set out to spend countless dollars and time learning something that is well…just overblown.
Many I have spoken to it has taken years after the fact for them to self-conclude that all along NO ONE could feel the things they were being told they should. Like Neil Pearson said recently ( I think it was him), it’s like telling someone they can read braille on the other side of a rump roast. And convincing them to spend tonnes of cash trying to do so.
It’s preposterous.
So I have a very hard time giving a program like that a “pass” because I learned “some stuff” if you know what I mean.
Sure the program eventually can be worthwhile, but the bulk of the “time” requirement is spent learning things that are to put it bluntly….useless.
I am a Physiotherapist 20 years in the making Jesse 🙂 yes, I took the courses back in the day when they were referred to as the E1V1, E2V2 E3V3 and so on. I latter took one of the quadrant courses just to see if the courses were advancing with the times and was horrified by what was being taught.
Question for you: If the program actually makes the relevant changes, then how will they define themselves as “special” when you consider many post graduate programs have actually evolved appropriately in the past decade? APTEI, EIM and even McKenzie come to mind.
It’s kind of like subluxation based chiropractic. If the chiropractic profession denounces the “subluxation” then what defines them now?
What justifies all the money and time then? To learn anatomy, red flags and some basic differential diagnosis skills? I can learn that autodidactically quite frankly.
I think probably the program being offered as a clinical masters is a step in the right direction given that there is some built in accountability with that (how can an academic institution which is supposed to uphold the virtues of the scientific process persist in teaching motion palpation and patho-anatomically driven Ddx?). Although….there is a university program centered around uhm….acupuncture so….well….I’ll let you draw your own conclusions there 🙂
BTW: You were on the same SFMA course I took in Toronto a few years back.
My impression from reading this post is that going through the levels can be useful for “solid foundation in differential diagnosis, screening for red flags and understanding anatomy at a much deeper level”, but after talking to others in the profession, it seems like going through up to level 2ish will give you a decent enough foundation in those areas without delving into the minute specifics of segmental motion palpation, etc. I’m a soon-to-be new grad that went into the PT program with the idea that I’d jump into the levels as soon as possible, but after doing some reading I’m questioning the utility of the later levels beyond the title and prestige associated with it. Especially if some of the research about manual therapy (and manipulations in particular) doesn’t favour experienced clinicians over novices.
Very interesting read! Thank you for sharing!