Physiopedia’s Rachael Lowe recently interviewed shoulder expert and physiotherapist Jeremy Lewis, PhD, FCSP of the London Shoulder Clinic. The video is now accessible for you to view!
Jeremy received his physiotherapy training in Australia, this was heavy in mobilization and manipulation revolving around the Maitland technique. He moved to UK and completed his PhD looking at postural influences on shoulder conditions. He has been awarded the Fellowship of Chartered Society of Physiotherapy, the highest honor a member can receive. Jeremy specializes in rotator cuff, shoulder instability, adhesive capsulitis, trauma, and surgical rehabilitation.
During this interview, Jeremy challenges the postural influences and the existence of shoulder/subacromial impingement. He notes due to a hypothetical paper written, there was an influx of the number of subacromial decompressions performed in the UK and Sweden. Yet there was not much evidence to support the subacromial impingement hypothesis. Exercise therapy has been proven to be more helpful than surgery for rotator cuff tears or impingement when targeting specific muscle imbalances. He believes the muscle imbalance is what causes the humeral head to elevate, rather than the position of the scapula.
Jeremy discusses neuromodulation considerations of the shoulder rehabilitation and using this when mechanical changes do not effect symptoms. He notes “What ever works as an assessment becomes the treatment. It does not rely on a structural diagnosis.”
Jeremy defines the SSMP model and outcome tool. He discusses postural effects of scapular posture, then humeral posture, then thoracic kyphosis which he has studied extensively.
Jeremy also puts a personal spin on his rehabilitation. He notes that it is key to understand how the patient’s shoulder problem is influencing their everyday life, what their expectations are. These are all key to the patient’s rehabilitative success.
Jeremy discusses various treatment considerations for adhesive capsulitis. He uses intraarticular steroid injections coupled with physiotherapy. His clinic also uses hydrodistinction. This uses ultrasound guidance to inject sodium chloride to provide a stretch from inside the joint also coupled with physiotherapy. Jeremy discussed the research supporting use of lidocaine injection with good results up to months and how this is a great alternative to a steroid injection, which can be potentially harmful to the tendon.